I think it should be written up- obviously something went wrong. Any unexpected event or death should be investigated by risk management- they are notified of these events primarily by incident reports.
I agree that the patient should not have left the OR- that kind of bleeding can't be stopped by nurses in any unit- that patient needed to go back to the OR. But we cannot refuse patients out of the OR for any reason other than no space in PACU. When the surgery is done is the surgeon's scope of practice only. We can make suggestions, though... Did anesthesia protest? Did the PACU nurse protest?
I have an idea why they went to the unit- it sounds like the PACU nurse was on call alone. If the surgeon brought the patient out of the room like that, I would sure as heck not want to be alone in the PACU with that situation. When you're on call you have to make the calls, get the supplies, hang the IVs, mix the drips, send the labs, deal with the phone, everything. Sounds to me like she wasn't dumping on you but asking for your help- she came up to deal with this with the help of other nurses around.
Write down everything you remember now for the sake of your own memory. Write the incident report. Ask the PACU nurse and anesthesiologist for their thoughts on what happened and why the pt came to the ICU.
Sounds like you did well under fire, though. Congrats.
Originally posted by Zee_RN
I'm newly appointed Charge Nurse in ICU, having work there as a staff nurse for >3 years. Had an event yesterday that I need input on.
We sent a patient to the OR for a lap chole. He was in a SR and on room air (88-years-old). The PACU nurse called me and said they were sending him straight up to ICU post-op because he was ventilated, on dopamine, neo and epi. OK, fine (? happened?!) but fine. Nearly immediately she called back and said "you need to send a nurse to the OR; he's crashing." Ummm...never heard of that! ICU send a nurse to the OR?! We couldn't do that and she said "OK, he's coming up right now." So this patient comes into the ICU with an ABP systolic of 50. Never got it any higher. We poured blood products and fluids and added levophed to the routine and desparately tried to get a central line in him (they sent him up with a 22g in his left hand and a 14 gauge angio cath in his neck!). After about 90 minutes of this (ABP never higher than 50) with blood pouring out of his JP drain requiring constant (every minute) emptying, we took him back to the OR where they found a bleeder (big surprise) and fixed it. He came back and we were able to wean some of the pressors off (down to dopamine 6 and levophed 16).
My question: doesn't PACU handle these types of crises? I thought that was the purpose of PACU--so they could send them back to the OR urgently if needed, under the supervision of the anesthesiologist. We DO NOT have an intensivist in our unit. We have family practice residents--on call. We just happened to have the pulmonologist there on the unit yesterday and HE managed the case while the patient was crashing in ICU and inserted the triple lumen. The surgeon paced uselessly back & forth.
I'm honestly looking for advice; I'm new to charge (only 6 shifts under my belt!) and I'm not sure what to expect from ancillary departments. The charge nurse who followed me said "did you write it up?!" Ummm, well, no. Didn't realize it was "write-up-able." What do you think?