PACU visitation & policies

Specialties PACU

Published

It saddens me that the PACU is such an ancient practice. When PACU's were first established in the 1940's, I believe and then became a standard in the 1950's, anesthesia looked much different. I believe hospitals need to find a way to update their policies and the PACU by allowing patients to be with their spouse or support person immediately after leaving the OR if they choose. PACU's should have bays with three walls and sliding glass doors for both visual and audio privacy. It is so frustrating that hospitals still think this is acceptable Care and practice.

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Specializes in OR, Nursing Professional Development.

Are you a PACU nurse? I'm going to guess not. Patients coming out of anesthesia are at a high risk for airway issues- a bay with 3 walls and a door that can close is going to hamper a nurse's ability to watch and listen to that patient when most likely they have another further along in the recovery process. Patients immediately out of the OR most likely aren't even aware enough to realize if a spouse or support person is there- and visitors can be a distraction or get into areas they shouldn't be in. The PACU where I work does allow visitors in limited circumstances- children, patients who are being held in PACU while waiting for a bed to open up. I've had those visitors end up wandering into the OR itself, a place with extremely strict infection control needs. Patients also tend to spend a very short time in the PACU. Perhaps it is you who is out of touch with the reality of this area of nursing.

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I'm not sure why you have to be defensive or insulting in your post.

I am not currently a PACU nurse, but did work in one. From what I saw the patients who were at risk were elderly, obese, and addicts-- again, not in all case, but most.

It has also been my experience that if we educate the persons spouse they will stay next to the patient.

I don't think my concerns are completely not valid. We let spouses in the ICU all the time where patients are sedated and drug.

As a nurse and a support person, my family has been in the room when people pass or are taking off life support, why is the PACU so different?

I just don't think there needs to be such secrecy. I believe more transparency is what we should be working for.

I mean, in our profession, didn't we at one time not let the spouse in the labor and delivery room? And use twilight drugs while women birthed a child?

I just think PACU policies are out of date. I think it would led to a lot less anxiety if patients and spouses/ support person could be together.

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My PACU bays have three walls. Only the isolation bays have doors that can close. The bays are really not big enough, however, for visitors. I agree with Rose_Queen, above. Patients are really out of it for most of the time they are in PACU. Recently I had a patient who boarded with me for a long time. Her husband came back for several 15 minute visits, over the course of about 5 hours. As I was getting her ready to be transported upstairs, she said to me, "I don't even remember the first couple of times he came, and 15 minutes is a long time when you're down here. All I really want to do is sleep, not talk to him. Now I understand why you limit the visits!"

In my opinion, apart from special circumstances (kids, special needs patients, long boarders), it doesn't benefit the patient to have their spouse/support person present in PACU. It doesn't ease their mind, it doesn't help them rest and recover. It does help to tell them that their family member/friend is nearby, or will meet them up in their room. Having worked ICU, I'm going to put it out there and say that most ICU nurses feel the same way. It often makes the patient more anxious to have family around in ICU. They sleep better, for example, when they feel like they don't have to be awake for family. Can family visit? Of course. Should they be there 100% of the time? I don't think so.

Not only that, it generally does not benefit the family members. Virtually all of them feel overwhelmed and are made anxious by the environment. Our Phase 1 PACU is hopping. I am trying to make sure my patients have good airways and stable heart rhythms when they are at their most vulnerable. I do not have time to spend doing extensive education (again, same day surgery is a different story). We don't have room for chairs in the bays. No, you can't bring in your soft drink and Burger King meal. You can't go out that other door that you think would be closer, because it leads to the OR. There are no bathrooms available. I could go on....

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Specializes in PACU.

Agreed, that for the most part PACU is not the place for family or visitors. We have had someone, on occasion, just as PPs have said, small child, disabled or holding for a long time.

This can be difficult because we are an open room with curtains that we rarely use.

Families are not prepared to see emergence delirium, or simply lights are on but no-ones home yet. They have a hard time understanding that the patient rated their pain a 5 five minutes ago and you gave pain meds but now it's an 8 (normally because now they are awake enough to understand). And they get very upset when their loved one doesn't recognize or respond to them they way they normally would.

I agree transparency is important. I expect my work place to be transparent with financial issues but I don't expect to look at the financial books. So what I mean is when I take a patient onto the next level of care I talk with the family about what the PACU stay was like for that patient, things I did, medications I gave (or didn't give) and why and ask if they have any questions for me. Number one question??? Did they say anything funny?? Did you video it?? (which my answers are always no and no, even if they did say something funny, transparency doesn't mean I'm going to rat someone out when their filter has been hijacked by medications).

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Specializes in Psychiatrist.

Recently my wife was in for an outpatient surgery. It was her first time under GA.  Although the medical staff was first rate and all went well I was taken aback when it came time for her to be discharged and I was not permitted to stay and assist her. Instead still groggy she was sent to a bathroom to get dressed.  Further she listened to the discharge instructions but remembers nothing she was told. Luckily she has me and we got her set up at home.  So perhaps when the patient has been moved to phase 2 it should be fine to have the caretaker present.  A number of states have addressed this in so called no patient left behind. In NC not only can a appointed caretaker be with the patient in PACU but in pre op also at the patients request. I think these institutional  hardline approaches are outdated and it looks like the state legislatures are going to do it for us. It’s a pity because in those situations it’s never what anyone wants. 

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Specializes in ER.

I 100% agree. It's totally ridiculous for a person coming out of anesthesia to be given instructions on aftercare.

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Specializes in PACU, Stepdown, Trauma.

When I discharge an outpatient from PACU post op, we always give discharge instructions to the patient's caretaker. I'll go over it with the patient as well if they are alert but don't expect them to retain any of it.  We always help the patient to dress after surgery as well. I'm sorry to hear that you and your wife had that experience—that sounds terrible! 

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Specializes in SICU,CTICU,PACU.

Might as well have the family members inside the OR too while you're at it!  PACU is no place for visitors and should be an open room for safety issues!  Why would you want to risk the safety of pts by having visitors inside the PACU and walls???  Image if they all had visitors so that would be an additional 10 people inside the PACU and what if another pt codes?  

Awful idea!

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