Post op Admissions During Shift Change?

[All4Seasons]

Hi,

Pacu nurse here wondering if I can have some feedback on how things work in your unit with respect to post op admissions while the night shift is getting their report. Does PACU hold on to the pts in PACU as a courtesy to the floor,or are you expected to take the admissions when ever they are ready to be discharged from PACU?

Our unit holds on to the cases,BUT we have to speed up the flow through PACU and we're looking at revising our policy.

Could you let me know the size of your hospital? whether you are a trauma centre? Thanks!

[NursKris82]

I work in a 300 bed hospital and usually pacu and er does not hold pts during shift change, but we wish they would. It makes report very difficult to get thru when you have to take report from pacu too and then you have a brand new post op rolling up before you've even hit the floor! It's terrible! The way you do it now is MUCH safer, trust me!

[kayern]

We have a 30-minute before/after report policy. Of course that's gone if the building is on high census (which it is frequently, with an occupancy rate over 100%) or if its going to hold up the OR. Its not courtesy but for patient safety.

[sistasoul]

Where I work the patients come up at all times of the day. I was told the ER docs will not get paid if they do not discharge the patient to the floor before the end of their shift. Our ER Docs are not employees of the hospital but of a group. Post ops come up any time also. Some Pacu Nurses are really considerate and wait for the floor nurse to call them back to get report if we are really busy. Of course it has to be in a reasonable amount of time. I like when the PACU nurse asks if this is a good time to bring the patient up. There is never really a good time as I never have any downtime. I just tell them to bring the patient on up because I know they are being kind when they ask this.

I agree that it is not safe to bring the patient up at change of shift. I try to get in the room to make sure the patient is breathing, not bleeding to death, and not in pain. I then try to do the admit as I can throughout the shift. I also do not like when I get a post op or ed admit at 2000. I go crazy trying to pass 2000 and 2100 meds while dealing with any patient changes while a new admit is waiting with the mountains of paperwork that go along with it. I have yet been able to figure out how to be able to pass meds and do the admit. If I have some idea the post op or admit is coming up at this time I try to pass meds a little bit earlier (as long as they are not antibiotics, cardiac, etc). There are usually not a whole lot of meds you can do this with though.

[Music in My Heart]

I just camped on a patient in the ER for 4 hours just to provide the M/S nurses time to get caught up on everything else they had. I did warn them, though, that if something came in she might have to come up before they were ready.

We're all in this together... if we nurses don't have each others' backs then we've got nothing at all.

[Meg, RN]

I work on an 18 bed med surg unit at a hospital without a trauma center. We much prefer to have PACU hold the patients until 1930, because it is ridiculous trying to give report when PACU is calling to give report on more patients during shift change. On our floor, staffing kinda stinks because early in the day, our charge nurse will see that "oh, we have a lot of empty rooms. I'll send one of the nurses home!" So then we only have two or three nurses to take care of the whole floor the rest of the day/night. And then at shift change, PACU calls and they bring up three (or more) fresh post-ops and we're running around like crazy. Some of the patients that are brought up, shouldn't even be on our floor because they are unstable and need to go to ICU, and then we spend even more time trying to work with the post-ops, that our other patients are neglected.:-( It's just courtesy if PACU holds the post-ops until after shift change. :-)