Preceptorship in the PACU

Perpetual Student · Oct 17, 2012

How do you prepare for the day?

Get dressed and wander in with a grin. Whoever is the first in should check that the bays are all set up. Take a look at the schedule for the day to get a feel for what's gonna go down, but expect everything to change. Be sure to say hello to everyone and see if anybody needs help (assuming you're not the 1st one in, not quite as applicable to a student who should be hanging close to the preceptor).

As a student, study up on your drugs (opiods, pressors, benzos, ABX of choice, etc.) during down time and at home. Be familiar with the different anesthetic approaches and their implications--regional, neuraxial, general (TIVA vs. gas). Try reading up a little bit on the cases being performed that day if you're not familiar with them. Ideally, spend some time reading Drain's Perianesthesia text if you can get your hands on it. Don't be afraid to ask questions, as it is impossible to anticipate and study everything that will come up in a day.

One thing I want to add: if your preceptor tells you to be quiet or get out of the way, please do it and observe closely. Some situations take the experience and finesse of an experienced PACU nurse. I'll talk my preceptees through just about anything, but when the patient's comfort or safety is at significant risk I may need to step in.

Any tips on time management?

Never put off what you can do now. When you receive your first patient do as much as possible as quickly as possible (while still doing it correctly) before you get your second patient. Don't delay your documentation unless clinically necessary. If you're giving chin support your other hand can be documenting assuming your patient is stable.

Without freaking out over it, always expect that in 2 minutes you'll have another patient. That way when the OR forgets to call out and goes "SURPRISE!" as they come into the PACU you're not overwhelmed.

Think about patient disposition the moment the patient hits the PACU, or better yet once you know you're taking him. Is the current bed assignment appropriate? Will this patient require a higher level of care than planned? The sooner you can get issues like that addressed and let the house sup know the sooner you can get the patient moved.

Your job is not merely to care for the patient, it is to stabilize him and transfer him to his destination unit in an expeditious manner. Anticipate possible complications and how you would identify them and respond. Be proactive in preventing issues that you can. Part of getting him ready is to optimize his comfort, of course.

Do not wait too long to start working in the opiods if appropriate. It'll take you way longer to get your patient's pain under control if you let it get insanely horrible. If the patient's arousable and showing signs of pain or complains of it, go ahead and give some meds.

If X-rays are ordered arrange for them to be done as soon as you're aware--you don't want to be delaying transfer while you wait for radiology to show up. Same goes for labs. Review your orders as soon as they're available and you have a moment.

Bellarara · Oct 17, 2012

Thank you so much for the insight!