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?
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.
The vast majority of ours come out without tubes. If they come out with a tube and the plan is NOT to extubate them, they go straight to ICU. If the plan is to try and extubate them but they were unable to in the OR, they come to PACU. Occasionally when they come to us tubed and then are extubated, they end up reintubated, or can't be extubated, and then go to ICU anyways. But a good 98-99% of ours come out with either just an oral airway in or nothing.
Specializes in OR, Nursing Professional Development.
The vast majority of ours come out without tubes. If they come out with a tube and the plan is NOT to extubate them, they go straight to ICU. If the plan is to try and extubate them but they were unable to in the OR, they come to PACU. Occasionally when they come to us tubed and then are extubated, they end up reintubated, or can't be extubated, and then go to ICU anyways. But a good 98-99% of ours come out with either just an oral airway in or nothing.
I'm from British Columbia. We have 12 bays in our PACU, 4 step down unit beds near by (which sometimes admits patients directly from OR if the other 12 bays are full) with 11 ORs running. We have no call bells. We have to give our patients those silly table bells you find at hotels if they are staying overnight. We don't get the cardiothoracic surgeries as they go directly to CSICU. I would say 90% of our patients come out extubated. We only get intubated patients that will probably be extubated within 24 hours or if ICU is full. It's not common for us to get preop patients since we don't have the space or staff. It only happens about once or twice a month for specific reasons that I'm not aware of. Our preop patients generally stay in ER or on the ward until they are called to the OR.
My PACU has 16 bays, but 7 of them are used as what's called pre-op holding until around 1600. The PACU and pre-op bays are partitioned by a curtain. The pre-op holding area has a separate entrance and we make sure no patients or family members pass by the PACU bays. I think it works well enough, as long as OR staff grab patients quickly enough.
The vast majority of ours come out without tubes. If they come out with a tube and the plan is NOT to extubate them, they go straight to ICU. If the plan is to try and extubate them but they were unable to in the OR, they come to PACU. Occasionally when they come to us tubed and then are extubated, they end up reintubated, or can't be extubated, and then go to ICU anyways. But a good 98-99% of ours come out with either just an oral airway in or nothing.
Same here, also in the US. We are a bit smaller, 8 bays, with one as a separate room that we use for isolation pts & for pts that PACU pre-ops if it's open. We usually pre-op inpts that are unable to get out of bed (pre-op area rooms are too small for beds). If we are too busy to do the pre-op, a pre-op nurse will come over to PACU to take care of that pt. If the iso room is already full or during after hrs/weekends, we usually bring a pre-op pt into the bay in a corner & pull the curtain. If on the monitor, we can still see everything from the monitor at the desk. If there isn't a pre-op/PACU nurse available to pre-op, then the circulator & CRNA will take care of the pre-op process.
How interesting. I'm in Syd Australia and at our facility I would say 80-90% of pts come to us tubed. But majority are LMA's with maybe 20% ETT. The anaesthetist does not have to stay for emergence unless we ask them to. If it was difficult intubation they would just do it postop in OT for us.
Preop pts in PACU: this never happens. If they are already admitted and for some reason cancelled they will just be transferred to PACU 2 (step down PACU).
However, we do do cardioversion procedures in PACU- we cordon off the corner bay and draw the curtains, then recover them in the same bay. So obviously the pt will come in from preop straight to us with no drugs on board.
I'm from British Columbia. We have 12 bays in our PACU, 4 step down unit beds near by (which sometimes admits patients directly from OR if the other 12 bays are full) with 11 ORs running. We have no call bells. We have to give our patients those silly table bells you find at hotels if they are staying overnight. We don't get the cardiothoracic surgeries as they go directly to CSICU. I would say 90% of our patients come out extubated. We only get intubated patients that will probably be extubated within 24 hours or if ICU is full. It's not common for us to get preop patients since we don't have the space or staff. It only happens about once or twice a month for specific reasons that I'm not aware of. Our preop patients generally stay in ER or on the ward until they are called to the OR.
Work in a 24 bay PACU. Phase II closes at 2100, so any cases going home or waiting to be started come into the PACU at 2030. Fresh OR cases are recovered and sent to their rooms or to ICU. All while answering the questions of the family members of when their surgery will start and discharging the other patients home. We do have a good anesthesia team though. They extubate the patients and keep them comfortable before passing them over.
I am in the states, and the PACUs I have worked in for the most part have done preops as well, however, then they have to staff a little better, because they really do have to try and keep them as separate as possible even though you are in the same space.
OR tends to call for patients far too early, then the patient takes up valuable PACU space and staffing because the OR didn't bother to be accurate. In 3/4 facilities I have worked in after the OR call for the patient they are then expected to be responsible for monitoring the patient, even if its just having a support person around. Of course it seldom happens, and the PACU end up babysitting anyways.
Its a poor model or care, its hard for the family of the preop patient to be so restricted, stressful for the preop patient, detracts from good privacy for the post op patient, and places a larger than needed burden on nursing staff.
chickhatz
9 Posts
I'm in Canada