PACU DOCUMENTATION/ASSIGNMENTS

[Alison Kirkpatrick RN]

So one of our veteran nurses has recently challenged the way we document in PACU. There is no current SOP for frequency of documentation, so I have always adhered to the 15 minute rule while in Phase I PACU (meaning I reassess every 15 minutes with the vitals after the initial assessment and vitals q5m x 3.) for recovering generals and minimum of 1 assessment for Phase II. If the patient is unstable of course I would assess more frequently. She also has challenged the way we do assignments, we used to assign a nurse to an OR but some felt it was unfair if some had 5 cataract vs a room full of general surgery, now we alternate according to what time your shift starts. I am not a fan of this because some people manipulate to get a lighter patient load. Sorry in advance for the lengthy post, thank you for any help.

[Rose_Queen, BSN, MSN, RN]

Do you have a post-anesthesia management protocol that spells out what care must be completed? That is what my facility bases minimum documentation requirements on.

As for assigning patients, it is based on where an open bay is (provided that nurse does not have a fresh out of the OR patient). Patient conditions vary; it would be impossible to just say this nurse gets all patients from this room that nurse gets all patients from that room because there's no guarantee the previous patient will be ready to leave when another is coming in.

The expectation is that the OR circulator calls the PACU charge to give them a heads up on who is coming out and the charge assigns the bay based on: is nurse on the unit and not transporting, what bay is open, isolation needs, etc. Loosely (when possible) patients go around the unit. Nurse A has bay 1 &2, Nurse B has bay 3&4, Nurse C has bay 5 &6. Bay 1 gets first patient, bay 3 gets second, bay 5 gets third, back to nurse A with bay 2 for fourth patient and so on.

[WalterWho]

Its worth mentioning that ASPAN publishes their recommendations for frequency of vitals, assessments, etc. Where I work, our policies often mention adhering to ASPAN standards and guidelines. As for patient assignments, I've heard some pretty wild methods including one that broke each type of case down to a point value and then however many points each nurse had at the time would determine who got the patient. Personally I prefer simply sticking to a turn base system without regard to what OR the cases are coming out of. Sometimes you might get screwed, but other times you make out like a bandit, but there's less manipulation this way.