Hi, Just wondering how pt's with epidurals for post op pain management are cared for in your hospital.
I work on a surgical unit with many ortho and abdominal surgeries. We have a room with 3 beds which is our "concentrated care" room. Right now our policy states that when a pt comes to us post op with an epidural, one RN must be assigned to that room. She can have up to 3 pt's with epidurals. She can not have other pt's and must be replaced by another trained RN when she goes to break or has to leave the room for more than a few minutes. The level of nursing care changes according to the anesthetist, ie: the RN may be able to go to break without being "replaced" in the room the next day and may have other pt's the day after that. (this room is on a reg surgical unit and the other RN's can just cover this room while you're on break).
V/S are BP, P, R, T, SpO2 q 1/2 hr for 2 hrs, then q1hr for 8 hrs, then all V/S q4hrs and R, and SpO2 q1h until the epidural is stopped. Of course neuros, pain management, sedation are checked qh. And when there's an increase in epi rate these vitals are more often.
I understand that in some hospitals these pt's come on the reg surg unit and is a part of your reg team of pts. What I'm wondering is, do you have epidurals as part of your reg load or do you have a room similar to the one I describe? This nursing shortage is making it extremely difficult to staff the floor adequately because no matter what, an RN HAS to be in our concetrated care room when fresh epidurals are admitted. This leaves the rest of the RNs with a very heavy workload.
Our epidura pt's are part of our pt load also. more frequent vs in the beginning, q1 hr checks the first 12 hrs. They have standing orders for decrease RR, itch, nausea and supplemental meds such as toradol or nubain. ALL our epi pts have to have a continuos pulse ox. We also have to have someone double sign when you hang a new bag or change a rate.
Our epidural patients are also, as in previous replies, returned to the med/surg floor. These patients do bear closer monitoring, but we do not have a room for them. They are placed in a regular room. They are placed on a monitor once they come back from the OR so that vitals can be continously monitored. This is part of our protoccol and they remain on that monitor until the epidural is DC'd.
They need to be closely monitored due to sedation rates and lack of ambulation at first. Aggressive use of incentive spirometers must be inforced. Patient education is key.
As charge nurse, if when giving out assignments I assign an epidural patient to a nurse, I try and give them a lighter patient assignment due to frequent monitoring of vital signs of that patient.
I belong to the group of nurses who believes in the overkill of care for the first 24 hours for epi patients. The patients have better outcomes, problems with pain control, site leakage, site edema, local reactions of any sort need to be monitored closely. I just do not think a nurse should be assigned a full load if she has a post epi patient. That said, management usually does what it wants to do and the nurse if left to do the best she can for all of her patients.
Pt's with epidurals are just part of our regular patient load. Only difference I've seen is that some of them are on a continuous pulse oximeter for awhile after surgery, and that we're very careful when moving the patient about. If the pt is having poor pain control, we call the anesthesiologist to come and increase the dose.
lovetoride
18 Posts
Our epidura pt's are part of our pt load also. more frequent vs in the beginning, q1 hr checks the first 12 hrs. They have standing orders for decrease RR, itch, nausea and supplemental meds such as toradol or nubain. ALL our epi pts have to have a continuos pulse ox. We also have to have someone double sign when you hang a new bag or change a rate.