Pediatric Recovery on Peds Floor

[pedseducator]

We had a baby who recieved a liver biopsy in the OR then transferred to the PACU (recovery) and PACU wanted to transfer the infant to the Pediatric Floor one hour post procedure with vital signs every 15' X4 then every 30" X4 then every 1 hr X 2. Our nurses routinely have an assignment of 5-6 children. We are concerned that the safety of this child is at risk. Yes, adults go to the floor but a blood loss for a 200# man and an infant are dramatically different in the event of a hemorrhage. I am concerned that if this will be the practice, it is a matter of time before a horrible incident will happen. What is your hospital's policy for pediatrics? Any advice?

[ICRN2008, BSN, RN]

At my hospital patients can be transferred to the floor as soon as vital signs are stable and their sedation level is acceptable. I'm not sure if there is an official policy but there should be. Our orders are generally for hourly vitals for the first few hours, but I have had some kids with q15 or q30 minute vitals when they hit the floor. This can be a dangerous situation if staffing is not appropriate. If you and your co-workers have concerns, I would talk to the manager immediately. There have also been situations when the recovery room sends the patients back up to the floor too sedated, unstable, etc. Nurses have refused to accept report on those patients until the patient is appropriate to be transferred (ie able to be woken up without having to resort to a sternal rub).

This sounds like a pretty serious patient safety issue- I hope that you are able to have it resolved soon!

[EmilyUSFRN, RN]

our p&p for post-op patients is vs q 30 mins x 2, q 1 h x 2, q 2 h x 2 then q 4 standard floor vs.

also, for anything requiring q 1 h or more frequent (like resp. nebs), we can only do it for 2 h, anything beyond that the child needs to go to the ICU for more frequent monitoring.