Is my Phase II properly staffed?

[justhere99]

Hello everyone, I just wanted to get some insight from anyone who has experience doing Phase II recovery for day surgeries. I am currently in a unit that many nurses do not seem to happy to be in. The expectation is to have patients discharged around 45 minutes, this includes putting in discharge orders, doing at least 2 sets of vitals, giving pain meds and other meds as needed, prepping patient file, charting, patient teaching, charging supplies to patient, going over discharge teaching, wheeling patient to vehicle and handling other issues such as taking patient to bathroom and helping them change, removing IV etc. With 1 patient I am able to keep up the pace some times with 2 patients I can keep pace assuming patient doesn't need help with dressing and bathroom but when given 3 patients it seems like too much to do in a little time. In order to get everyone out in 45 minutes I would need to complete these task on each patient in about 15-20 minutes which seems impossible. I just wanted to see if this is the way all phase II departments are or if there is too much expected in a little amount if time in my current department. I just feel stressed and am running around never able to catch up. I get nursing is fast paced but this seems excessive to me. Thanks to everyone who responds.

[londonflo]

14 minutes ago, justhere99 said:

n given 3 patients it seems like too much to do in a little time.

I cannot imagine anyone being able to do all this with 3 people in 45 minutes...You have to safe guard against falls (getting up, getting dressed, to the bathroom,  getting into the wheelchair and then into the car) , provide proper teaching to a cognizant patient, and  subsequent documentation of all you have done. Who ever devised this must have read the 'manual of multi tasking' without realizing the current thinking is that multitasking means 'nothing gets done well' .

I do not know what Phase II recovery means, but I cannot not even fathom doing all these tasks with 3 people. Heck getting 3 separate hamburger orders can take more than 45 minutes from a drive-through. 

[Rose_Queen, BSN, MSN, RN]

34 minutes ago, londonflo said:

do not know what Phase II recovery means,

These are the patients who have had surgery, spent time in PACU if needed (local anesthesia would go direct to Phase II) and are getting ready to go home that same day they had surgery. 

OP, I would recommend taking a look at the ASPAN standards. I’m the OR side of perioperative, so I’m not sure exactly what they state for Phase II

[londonflo]

1 hour ago, Rose_Queen said:

(local anesthesia would go direct to Phase II)

Is this like cataract surgery? 

[Rose_Queen, BSN, MSN, RN]

17 minutes ago, londonflo said:

Is this like cataract surgery? 

Anything that wouldn't involve an anesthesia provider. I've seen mediports done under local anesthesia, EGDs and colonoscopies done under moderate sedation, lump/bump removal under local anesthesia, etc. These types of patients shouldn't require the resources of Phase I, aka the recover room/PACU level of care.

[londonflo]

33 minutes ago, Rose_Queen said:

EGDs and colonoscopies done under moderate sedation,

Thank you for clarifying this term (Phase II). But as a patient and a spouse of a patient, I cannot say getting me/him out  safely in 15/45 minutes has not been my experience.

[justhere99]

We get all kinds of patients here such as chole, GI related, hernia, lapascopic, tubal ligation, prostate etc.

[RainMom]

Surely they don't expect that every single phase II pt is ready to discharge by 45 minutes? That seems very unrealistic unless all the pts are simple things like cataracts or endoscopies which can often be discharge at about the 30 minute mark (our policy minimum). On average, we probably have most other pts stay about an hr. But many cases like mastectomies, breast reconstruction, cholecystectomies, etc often stay closer to 2 hrs. We never set a time limit on when a pt should be discharged (although some pts DO need a little extra encouragement, LOL). 

We usually don't have more than 2 pts although picking up a 3rd isn't unheard of. As far as wheeling out pts or doing some of the hands on, is there never anyone between tasks that's able to jump in & help? On busy days, we grab anyone with a few free minutes to help walk a pt to the restroom, dc an IV, or take them to their vehicle; sometimes even calling over a Phase I nurse if they are having a lull while Phase II is slammed. 

I also wonder why you are having to put in discharge orders; that should be on the surgeon to complete.  Otherwise, is there not a charge at the desk that can help facilitate that?