Phase 1 PACU used as pre-op

[chickhatz]

Hello All:

Anyone else out there work in a (PACU) Phase I recovery unit, that also has pre-operative patients in the room with tubed recovering patients? Hospital management has stated we will be accepting Pre-operative patients to PACU after 1500 hrs and on the weekends. The support systems of these patients would wait in the waiting room. We do procedures on children and there is no exception for parents to attend in the PACU.

This has come about as the transportation system in my hospital is unreliable as to the time the patient would be brought to the OR once the OR nurse has called for the patient. OR staff currently call hour(s) prior to when the next patient would be going into the OR. Wait times for these patients are increasing with anesthesia leaving to attend elsewhere in the hospital and surgeons not present or available to start their case. Patients have been bumped waiting for an acute case and left waiting in the PACU till this case is completed.

We have had two breaches of privacy and one patient had an anxiety attack witnessing what the general public doesn't get to see in a recovery room that takes tubes.

Anyone else have any experience with this or guidance?

[Rose_Queen, BSN, MSN, RN]

After 1630, our preop patients go to the PACU area instead of the preop area due to staffing being reduced to one nurse. However, these patients are segregated off on one side of the room while post-op patients are on the other side of the room, and they are separated by the nursing station. Family (1-2 people) are allowed to be with the patient. We also only call for these patients as the OR is ready for them to prevent them sitting in the PACU area for hours at a time. On occasion, they do get bumped by an emergent/urgent/trauma surgery. The preop nurse and the OR charge nurse discuss whether to keep the patient there if it's a short case or whether to send them back to the floor. If the patient came from the ER, they must stay regardless as they no longer have an ER room and haven't yet been assigned a floor room.

[OlivetheRN, ADN, BSN, RN]

Like Rose Queen, our pre-op patients will go to PACU after 1630 due to staffing. We have a pretty small PACU so we will typically pull the curtains and give them the call bell if they are alert and oriented and have family with them for their privacy and privacy of any recovery room patients we may have at the time. Other times we may have pre-op patients from the CCU that need additional monitoring so we hold them in PACU instead, even if it's before 1630.

[chickhatz]

Can your pre-op patient's see your post op patients?

Unfortunately we do not have call bells. Our PACU has 12 bays and we accommodate 11 OR's. We have bed flow issues at the best of times. By pulling a curtain around the pre-op patient we would not be monitoring them as per hospital standards. As our PACU very small family is not able to attend with the patient, hence the anxiety level of these patient's increases as the watch patient's coming in fighting and tubed. They have long stays at times which adds to the patient and families anxiety.

[Rose_Queen, BSN, MSN, RN]

Is coming out of the OR tubed the norm in your PACU? Why are these patients not extubated in the OR or sent to ICU?

[chickhatz]

I should also add that these Pre-op patients also include children. On the weekend PACU staff admit around 6 patients which we use to leave in the waiting room. Now these walking patient's are expected to sit in PACU waiting their turn in the OR as there is no one in the waiting room to assess them. Thank you for your input OlivetheRN and Rose_Queen.

[chickhatz]

I would guess that 90% of our patients are tube. The anesthesia department feels it helps quicken OR turnover times if we finish their anesthetic.

[chickhatz]

Many times we stabilize the ICU patient's there is also usually a bed issue in ICU so they don't go direct. Many of our cardiovascular surgeries they like to remain close to the OR so they stay in PACU and go to the ICU after an hour or so.

[chickhatz]

When responding can you please let me know what province you are in? I'm in Ontario.

[OlivetheRN, ADN, BSN, RN]

Can your pre-op patient's see your post op patients?

Unfortunately we do not have call bells. Our PACU has 12 bays and we accommodate 11 OR's. We have bed flow issues at the best of times. By pulling a curtain around the pre-op patient we would not be monitoring them as per hospital standards. As our PACU very small family is not able to attend with the patient, hence the anxiety level of these patient's increases as the watch patient's coming in fighting and tubed. They have long stays at times which adds to the patient and families anxiety.

We're not a large PACU either. 12 bays to 10 ORs. Yes, we have call bells but they are rarely used. Honestly, I think the only times they're used is for the rare times we have pre-op holds that are truly alert and oriented. We are fortunate that the way our PACU is laid out has two bays that are slightly inconvenient to use for recovering patients but is a great spot for holding patients or other random things like blocks and blood patches and stuff like that.

With regards to family, we try to let family back, but there are times when we simply can't. Crap hits the fan and cases have been behind all day and add ons have been piling up all day and space is at a premium. More often than not those are the days we simply can't hold pre-op inpatients in PACU and the OR has a spot that just barely fits an inpatient bed and a family member or two around the OR area where they are able to be monitored. Worse comes to worse, the same day manager is amazing and has been known to stay late and watch pre-op patients.

90% of your patients come out tubed?! Seriously?! That's nuts! No wonder you guys have flow issues in your PACU!

[OlivetheRN, ADN, BSN, RN]

When responding can you please let me know what province you are in? I'm in Ontario.

I'm in the United States.

[chickhatz]

lol thanks I needed the giggle. Do all your patient's come out without tubes? Now by tubes I mean ETT, LMA and the occasional nasal ETT for dental surgery.