Pre-Op in PACU

[Sassafras, BSN, RN]

Hello PACU nurses,

I just wanted to reach out and see if any of you had experienced a workflow that included all ICU/PCU patient’s coming to PACU to preop. We had a leadership change and the concern brought forward was that critical care patients were coming from a higher level of care to a lower level of care when in preop. Within our facility preop is considered outpatient/medsug level. I am not referring to weekend or night emergency cases, but rather scheduled Monday through Friday cases. 
 

I am the Daytime PACU charge and I am having an incredibly hard time managing the flow of fresh recoveries and critical care preop patients in one 8 bay PACU with limited nursing staff. Has anyone seen this work successfully? Do you have any advice or tips? I am feeling very overwhelmed as these patients have multiple issues and are not properly optimized for surgery in the ICU or consented for anesthesia. 
 

Please make note, per ASPAN standard we do not have the same nurse doing preop and recovery at the same time. Also, the eventual goal of the department is to have a preop holding area to decompress inpatients from PACU and outpatient preop. 
 

I appreciate any and all feedback. 

[RainMom]

Our pre-op/same day surgery dept preps all OR pts including ICU. With add-on cases, PACU sometimes will prep a pt if SDS is short staffed & our staffing allows.  If a pt is truly critical, they bypass pre-op altogether with the OR team/anesthesia doing their bedside visits in the pt room & taking pt directly to surgery.

[MakeItRain]

I may be going out on a limb, but if you only have eight PACU bays, then there's a good chance that your facility is small enough that PreOP and PACU are staffed by the same nurses in a rotating basis, in which case the PreOp nurses ought to be "competent" in Phase I care, which would then deem them appropriate for PreOp of ICU level patients, but that's just my thoughts. I've worked in eight different PACUs (and preops) from outpatient surgery to very large level one trauma centers and I've never heard anyone making this argument, but it does kind of make sense... but then again, I've always said that if I'm getting called in in the middle of the night for an "emergent" life-or-limb case then don't expect me to monitor said emergently ill preoperative patient on one side of the PACU while I recovery another emergently ill patient on the opposite side.