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PACU recovering patients in the ICU?

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QCG33k QCG33k (New) New

Has 1 years experience.

Hello fellow PACU nurses, just a simply inquiry to see if other hospitals does this.

If an anesthesiologist is planning on leaving the patient intubated they obviously get a straight-to-ICU boarding pass. However, there is an expectation for PACU nurse to accompany the patient over to ICU and be the primary nurse for the initial 30 minutes. Does anybody else's hospital have it where you are traveling to a different unit to "recover" a patient in ICU?

Just to clarify this isn't saying we receive a patient in PACU and determined they need ICU care and upgrade them to an ICU bed. We are talking about a planned ICU patient staying intubated.

Thanks for your feedback!

 

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Generally speaking the 1:2 ratio of an ICU should be sufficient for a 'stable' phase I PACU patient. 

In my experience these sorts of rules (requiring a PACU nurse to initially recover or help recover a patient), comes from poorly handled situations prior that. 

A common pet peeve is the patient who goes to the OR due to a perf'd bowel for instance, and is then sent to the ICU directly from the OR with no central line, pressors ordered, etc, and with the Intensivist not even yet consulted by the surgeon or anesthesiologist.  Post perf'd bowel clean-out the patient will inevitably crump, so the ICU nurse now has a patient under their care without even so much as an "admit to ICU" order yet to at least be able to override meds, and that's in addition to their other critically ill patient.  In those situations the patient should really continue to 'belong' to the OR and PACU until they've safely handed off the patient.  

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

It’s been years since I worked PICU, but the PACU RN would come with the patient to the ICU but then we would immediately take over care of the patient. 

0.9%NormalSarah, ADN, RN

Specializes in ICU. Has 2 years experience.

Our PACU recoveries done in the ICU are done by us, the ICU nurses, 1:1 for at least the first hour. If we have another patient, they go under the care of the resource nurse for that hour so that we can properly care for and document on the recovery. Not sure if this is always necessary, but it sure does help so you don’t miss anything important happening in the recovery phase. 

Patients that stay intubated do not need to be recovered, therefore, no pacu nurse is needed.  My unit has our own nurses that recover non intubated patients if there is a bed available.  

RNperdiem, RN

Has 14 years experience.

No PACU nurse needed here either. In SICU, anesthesia and the surgical team transport the patient to the unit an do a bedside handoff with the ICU docs and the ICU nurse. PACU nurses are not involved

JBMmom, MSN

Specializes in Long term care; med-surg; critical care. Has 9 years experience.

23 hours ago, MunoRN said:

A common pet peeve is the patient who goes to the OR due to a perf'd bowel for instance, and is then sent to the ICU directly from the OR with no central line, pressors ordered, etc, and with the Intensivist not even yet consulted by the surgeon or anesthesiologist.  Post perf'd bowel clean-out the patient will inevitably crump, so the ICU nurse now has a patient under their care without even so much as an "admit to ICU" order yet to at least be able to override meds, and that's in addition to their other critically ill patient.

Were you in my unit this weekend?! I got a 15-30 minute heads up that the patient would be coming to the unit after surgery for ... you guessed it- perf'd bowel. I quickly found that this patient with a known IVDA history had a 22# in the AC and a EJ so I gave the PACU nurse a called and asked if they could request a central line before he comes to ICU. Since sedation *might* be a challenge when the heroin, cocaine and marijuana wear off on top of the roc and prop. Next thing I know a patient is rolling through the unit and all I have are "admit to ICU" and "Q3 hr dilaudid" for orders. We've had a number of dumps in the past so I admit my hackles were up a bit. I told them the patient was not going to be wheeled into the room and I would not accept care of the patient until I had the appropriate orders. Fortunately, the new surgeon had accompanied the CRNA and circulator nurse and he got right to work. And when I mentioned the central line they all said it was unfortunate that no one thought to have it placed in the OR, now we would have to wait for the surgical PA to get there. I was fit to be tied and told them that, in fact, someone HAD thought of it and I even called over to the PACU to have the nurse request one!!

Well, that was a bit of a tangent, sorry, but thanks for listening. As others have said, if intubated patients come over there isn't really a recovery since they're staying intubated. As long as we do have the correct orders and consults, it's not an issue and a PACU nurse isn't needed.