PACU/Recovery room Visitors

djmatte, ADN, MSN, RN, NP · Apr 8, 2018

Generally the best method I've found is to have an actively informative process between Pacu and family. My last two hospitals had a solid"concierge" service that kept families informed both through a digital board and by actively touching base. Getting families back was something of a priority, but nursing discretion was still paramount. In one place, they could accommodate up to two family members while the other only let one back. Another place had a phase two and never let family into phase one unless there was a room holdup and the patient was there for two hours.

What I found was there has to be a culture by nurses to have a willingness to try new things where it can feasibly be accomplished. What I found by getting family members back sooner than later is two fold. You get some more insight into family dynamic and patient norms that aren't commonly known in the periop environment and in many cases, more fidgety patients calm down sooner when family members are present. But if the nurses aren't on board with the idea or your facility isn't designed to provide the right space and privacy, then it is a bad idea to pursue.

Editorial Team / Admin · Apr 9, 2018

Thread moved to PACU forum.

brownbook · Apr 9, 2018

I'm totally guilty of allowing families back early and too many of them, when the unit census and patient acuity can accommodate them.

But all it takes is a quick aside from the charge nurse that the unit is getting too busy or the family needs to step out for a while, etc. and I comply. I have never had the family complain. They can see that the unit is getting busy and understand.

Have you tried just asking the charge nurse to "evict" visitors when needed?

Susie2310 · Apr 9, 2018

A PACU I am familiar with brings family members back once the patient is out of the procedure and in the PACU. I have never witnessed any problems, and I have been both patient and family member on multiple occasions. Family members are often very anxious to be with their loved ones once they are out of their procedure, and patients often want to have their family members with them as soon as possible once they are in the PACU after their procedure. As long as family members are well behaved I can't see any problem, and both patients and family are happy with this arrangement.

djmatte, ADN, MSN, RN, NP · Apr 9, 2018

A PACU I am familiar with brings family members back once the patient is out of the procedure and in the PACU. I have never witnessed any problems, and I have been both patient and family member on multiple occasions. Family members are often very anxious to be with their loved ones once they are out of their procedure, and patients often want to have their family members with them as soon as possible once they are in the PACU after their procedure. As long as family members are well behaved I can't see any problem, and both patients and family are happy with this arrangement.

The concern in many cases is privacy. Many Pacu are bare bones work limited space as it's only a newer phenomena of bringing families there. It's also who l why things like phase 1 and 2 are established in bigger facilities. To delineate where less monitoring is needed and to aid in patients moving to the next location with their families. The first Pacu I ever worked there was literally rough space between two patients was my computer.

Susie2310 · Apr 9, 2018

The concern in many cases is privacy. Many Pacu are bare bones work limited space as it's only a newer phenomena of bringing families there. It's also who l why things like phase 1 and 2 are established in bigger facilities. To delineate where less monitoring is needed and to aid in patients moving to the next location with their families. The first Pacu I ever worked there was literally rough space between two patients was my computer.

I am familiar with there being screens/curtains surrounding each patient. When family members are brought back they cannot see other patients. When I have been both patient and family I have never heard the presence of other family members who are with patients. Is that the situation you experience? What privacy concerns do you have?

RainMom · Apr 10, 2018

We rarely bring family into PACU to see post-op pts. Just about the only exceptions are if there is a hold for a bed greater than 2 hrs or after hrs if we discharge home directly from PACU when phase II area is closed; we did bring family back once for a few minutes shortly after pt came out of OR because he had coded during a routine appy but that was unusual & we were able to use our separate isolation room for privacy. We have a liason that floats between PACU & family to update them regularly.

We also prep inpts for OR. We do allow family to stay with them until they go back but try to keep them separate from the general PACU area. Never fails though, half of them will wander out to ask questions or just come to stand & gape at what's going on with the other pts until they are directed back to their own family member. Drives me bonkers & I can't imagine having every pt's family visiting.

djmatte, ADN, MSN, RN, NP · Apr 10, 2018

I am familiar with there being screens/curtains surrounding each patient. When family members are brought back they cannot see other patients. When I have been both patient and family I have never heard the presence of other family members who are with patients. Is that the situation you experience? What privacy concerns do you have?

I don't typically have concerns. But playing devil's advocate, a curtain worth a few feet of space doesn't provide much for privacy... Especially in a space where patient med administration and situations may be openly discussed. I've rarely seen a situation where a family can't see or hear other patients. Space is typically tight , so it's understandable if there are privacy concerns.

Susie2310 · Apr 10, 2018

But playing devil's advocate, a curtain worth a few feet of space doesn't provide much for privacy... Especially in a space where patient med administration and situations may be openly discussed. I've rarely seen a situation where a family can't see or hear other patients. Space is typically tight , so it's understandable if there are privacy concerns.

I think it is important to be sensible about privacy needs. When the surgeon or anesthesiologist have come to talk to me when I was a patient or to my family members when they were patients behind screens, they did so by the bedside, inside of the screens, and typically did not speak loudly and kept their conversation brief. More detailed information was provided on the discharge information sheet. I'm sure you are aware that HIPAA does permit incidental disclosure of protected health information: When reasonable steps are taken to prevent persons not involved in the patient's care from hearing information about the patient, if a very small amount of information is overheard, that does not constitute a HIPAA violation.

djmatte, ADN, MSN, RN, NP · Apr 10, 2018

I think it is important to be sensible about privacy needs. When the surgeon or anesthesiologist have come to talk to me when I was a patient or to my family members when they were patients behind screens, they did so by the bedside, inside of the screens, and typically did not speak loudly and kept their conversation brief. More detailed information was provided on the discharge information sheet. I'm sure you are aware that HIPAA does permit incidental disclosure of protected health information: When reasonable steps are taken to prevent persons not involved in the patient's care from hearing information about the patient, if a very small amount of information is overheard, that does not constitute a HIPAA violation.

I'm not worried about HIPAA in this. Just playing devil's advocate. It is likely that MOST PACUs are not set up to even handle family both from a privacy and a space perspective unless they have been built or refurbished within the past 10 or so years. That's been my experience at the 6+ hospital PACUs I've worked over my career. So it is understandable that many PACU staff are less inclined to accommodate family because they historically have never had that burden. I find family presence helpful when I work in PACU...but if I was asked to not bring them down for whatever reason, I would wait on it. As I originally said, if the space and acuity permits it, by all means bring them down when you can.

HeySis, BSN, RN · Jun 8, 2018

We rarely have family in our PACU. Space is tight and not all the curtains go around each bay tightly... so if you are walking by you can glance in, and if you had family sitting next to a bed the nurse in the next bay may trip over their chair. I have had another nurses pateint answer the questions I was asking my own patient, because we are that close.

For those that do, how do families cope withe the emergence delirium? Or seeing their loved one having a jaw thrust, or still intubated? We have all of these scenarios on a fairly regular basis.

And will tend to keep curtains open so we can help each other out during set up, if there are airway issues.. so that someone is holding an airway while the other charts and someone else maybe elevating and icing an extremity, getting warm blankets and such. Once a patient is awake and aware, of course the curtain closes. But until then, we like to be able to see and work together to help out.

I guess maybe finding out out how your patients normally score on an aldrete upon entering PACU might help me understand... if most of your patients are at an 8/9 already that would be very different then when normal is 5/6.

And are your PACU's close to the phase II? Ours is not, you go through OR hallways or have to go the long way around (which is not well marked, kind of hiden)with would mean personal just to take families back and forth.