Policy on length of stay in the PACU

brownbook · Dec 1, 2012

I hate, never memorize, standards and policies. Usually when I finally find the P&P book and find what I'm looking for the answer is so intentionally vague it doesn't answer the question.

Are you having a problem transferring spinal patients to the floor? Are the floors refusing to take the patient until the spinal is completely worn off?

I know that can be an issue and there may be no clear cut P&P answer.

If that is your problem ask your manager and or talk to the manager on the receiving unit what they think, prefer. The patient can't stay in PACU for 8 hours until it completely wears off......but I can hear the floor nurses complaining.......we can't receive spinal patients that aren't able to walk yet.

It seems if the patient can lift and move their legs in the bed, push against your hands with their feet, feel some sensation, etc., but not able to stand, they could go to the floor? But there I go again being logical!

GHGoonette, BSN, RN · Jan 12, 2013

The spinal issue would depend on whether your PACU has a phase 2 area or not. Small pacus like mine just take phase 1 cases, stabilize them and discharge to the ward/unit. Spinal cases, where there are no BP problems or operation-related issues we discharge to the ward, UNLESS the anaesthesia was administered at a high enough level to affect the muscles of respiration. They need to be monitored for a bit longer, as the tendency in the wards is to elevate the head, possibly resulting in migration of the local anaesthetic.

For GA cases, we just use the usual criteria for assessing discharge readiness, which differs from case to case. It may be as little as 15 minutes, where the patient is brought awake to pacu, up to 1 hour if there is PONV and pain control required, and two hours or more if we are not satisfied with the patient's condition, especially where it possibly relates to the operation and the question of post-op bleeding. I've kept patients for 5 hours where I suspected internal bleeding, and insisted that the surgeon (in some cases already on his way home), get his butt back to theater and sort his patient out.

hardyea · Mar 28, 2013

In my unit a regional needs to spend 1hour with us minimum, down 4 dermatones and be able to move their feet and bend their knees

PACURN1956 · Apr 1, 2013

Our criteria for spinal anesthesia is based on hemodynamic stability, patient not requiring medication for hypotension in past hour, and the patient must be able to turn their upper body to protect their airway. In the 15 years I have worked in PACU I have seen our standards change from set in stone same for every patient to a policy that is dependent on the patient meeting criteria. We do not have to wait for the spinal level to move a set number of dermatomes or be able to move toes as it was in the past. As our volumes have increased we would not be able to house all our postop patients if we were still waiting for the old standards.