PACU Staffing Ratios

[planny]

We have a small 4 bed PACU, phase 1 only. Our OR runs 4-5 rooms at a time. I know that according to ASPAN standards, we should have 8-10 beds. However, we have usually been able to keep up with the patient flow by having a 1:1 patient /nurse staffing ratio, that enables us to treat and recover most patients in 30-45 min. Recently, we have been informed that our staffing will be reduced, and to get ready for the standard 2:1 patient/ nurse ratio. How do you recover 2 patients at a time and still get them out in a timely matter? Do you have transport help? What is your average stay (phase 1) when you have 2 patients? Do you transfer the patient and chart later (doesn't seem safe)? Any advise would be greatly appreciated.

[meandragonbrett]

You chart, give meds, call report. It's a constant Race against the clock. When they meet discharge criteria they are discharged from PACU. There is no sitting around.

[emain86]

What I do is get my new patint settled in and pray they aren't screaming and trying to get out of bed ( if they are I'll start medicating and chart later i write it all down).

Then I'll go back to my original patient and try to keep charting getting him ready to go. I'll usually put in for transport and continue to chart. ( if your hosptial has transport that is). If not I'd get charting done and then send patient downstairs. During that time I make sure my second patient status isn't changing. Then I just chart all at once as long as everything is the same. For me it ends up being faster that way than going back and forth between screens on the computer anyways.

Im still trying to get used to organizing things the problem comes when you have both patients unstable. Then thats when you need to ask for help/delegate if possible.

[GHGoonette, BSN, RN]

How many of your patients are children? What percentage are still intubated when you receive them? Are they breathing? If extubated, are they maintaining respiration unaided? I asked a similar question a couple of years ago regarding the 2:1 ratio, and was told that it was "guideline only". I believe the NSW (Australian) staffing ratios calls for 1:1 if the patient still has an artificial airway in situ, and given the high acuity of PACU patients, even 2 staff members to 1 patient may at times be called for. A big question for all anaesthesia providers, to say nothing of the patients themselves and their families, is "Who is watching over me/my patient/my loved one?"

[enuff]

I would love to have only 2 patients at a time. Where I work we often have 2 nurses for 15-30 phase I & II patients. Safe? no way! Management turns a blind eye & believes saving money by reducing number of staff trumps patient safety & liability. Lunch is a dream, breaks are non-existent, overtime not allowed. Morale- what's that?