RNPamP

I don't know how helpful this reply will be b/c we hate our computer charging system too! We have a GE program for our entire surgical services from pre-op thru PACU and would give it a big . The system is very labor intensive as far as including more info than necessary and most items having to be typed instead of point and click or drop down menus. Oh, did I mention that it goes down all the time, and often freezes and the computer has to be reset :trout:? And what a waste of paper!!!! Our paper charts had 2 sheets of paper; the print out from the computer chart can be up to 40! As to the keyboard covers, we don't use them. They seem to just fall off anyway, I'm not sure how much of an infection control issue this is. I just clean the keyboard and mouse with a disinfecting wipe, and so far haven't caused any damage. I would love to hear from a PACU that uses a computer system that they like; it's too late for us since the hospital already paid hundreds of thousands for this one!

Hey PACU nurses! I was just wondering how many PACUs out there have patients holding overnight routinely (or even for a couple of days). Our bed situation here seems to be out of control, to the point where we have anywhere from 2-5 patients holding just about every night. Is this normal to anyone else? I have working in one other PACU and there it was rare to hold overnight; I just wonder which is more common.

Thanks to all who responded; I appreciate the interest. I did end up writing this guy up. I was going back and forth on the issue, and while I do see the viewpoint of those who said to just accept his apology, I draw the line at physical contact. I felt that if he just had a bad attitude and was nasty, that was one thing, but grabbing my arm took it to a different level. As far as I know, he was probably reprimanded and still occasionally see him, but he's not working here that much. Anyway, I really just wanted him to know how serious I felt this was and that to do so again would probably cost him his job. Hopefully, he will learn to control his anger/impulses in the future! Thanks again for the support.

1. My PCP must be a Nurse Practitioner! If I have any choice at all anymore, I always see an NP because... 2. They take the time to listen 3. They actually seem to care Of course, I know there are also great docs out there, NPs just seem to more consistently have the above qualities.

Nene's probably right, "refuses" is kind of a loaded word. But when you are telling a doc over and over again that a patient is awake and c/o 10/10 pain and they say they won't order anything, technically that is a refusal. I've always been taught that you should document exactly what actually happens, not to pick and choose what's going to get a certain person into "trouble". If they say it, they should be held accountable for it. Also, with the above case that I mentioned, the point was that she did notify the attending sugeon and was held accountable for his decision not to do surgery. So these incompetent docs must be reported not only for the patient's sake, but for the fact that we can be held responsible for not reporting their poor care.

I just want to respectfully disagree that you should "not put anything in the patient's chart". Of course, don't include any personal commentary or opinion, but you should be documenting exactly what this doctor says and does. That's part of "CYA". For instance, in the pain control scenario, document "patient c/o severe 10/10 pain. MD aware, refuses to order pain meds, stating (quote reason)." This way, you have shown that you did what you were supposed to do, and that you followed up on it. BTW, I recently read an article about a malpractice case in which a vascular patient was having pulse check changes; the nurse reported to the attending physician and he chose not to do surgery. The patient ended up losing a leg. Guess who was found liable---the nurse for not reporting up her "chain of command"! They claimed that she should have reported to the nursing supervisor even though the physician was aware. Scary! :uhoh21:

Thanks to everyone for the advice. I have written up the incident and reported it to my acting nurse manager, her supervisor, and the CRNA's supervisor (figured I'd cover all my bases). I'm glad to hear that others would also report the incident; I was trying to convince myself that it wasn't a big deal but of course it was. BTW, I think if he decides to write me up he doesn't have a leg to stand on, the patient met all criteria for the removal of the airway. Also, there is nowhere that it says "only CRNA's can remove airways" and he's only going to make himself look bad by saying he was going to leave in an airway on an awake patient. I stand by my decisions, and I managed to keep my cool!

Well, I would say that if the patient never complained to you about the door being open then their complaint is invalid. Patients often seem to think we are mind readers. This seems to happen quite often; a patient will seem content, not complaining, and then the family member comes and all of a sudden there are a million and one problems. I try to explain to the patient and the family member that if they would vocalize their problems to me, I'd be happy to help them! Again, I wouldn't worry about this too much, you would have helped this patient if you'd known there was a problem. You can't fix things you don't know are occuring.

I am wondering what the general consensus is with regard to pain control for post op CEA patients. In the hospital I am currently at, CEA patients are only written for tylenol for pain, and very rarely will they ever give something stronger. Their rationale is, of course, the importance of monitoring neuro status in these patients. But if this was the case, shouldn't we be witholding narcs on all cranis and other neurosurgeries as well? The last hospital I worked at, they had no problem giving carotids morphine or percocet, and the patients did fine with it. It seems cruel to me to withold these pain meds when they have done a surgical incision on someone's neck! Is this common practice anywhere else?

Hi everyone, sorry for the length of this post. I had a situation happen to me at work on Friday that I would like to get some feedback on. I am a PACU RN with 5 yrs of experience, and I consider myself to be extremely competent at what I do. Here is the situation: a male CRNA brought a lap chole patient out to PACU still intubated with an oral airway in place. Almost immediately upon arrival, the patient began to wake up, gagging on ETT, sitting up in bed, etc. At this point, the patient wasn't even on a monitor yet, and the CRNA extubated the patient. After the extubation, he turned away from bedside to throw away the tube and the patient contined to gag and cough quite severely on the oral airway. Thinking of risk of aspiration, I quickly removed the airway (which is something nurses on our unit do all the time). Also, there were 2 other nurses at the bedside with me who were both saying we needed to take the airway out. Anyway, the CRNA became very angry, saying "Don't you ever remove MY airway!". I tried to explain that she was gagging and seemed to be at risk for vomiting and aspiration, but he was too worked up. The next thing that happened is the part that I am thinking of reporting him for--he grabbed my arm and tried to pull me away from the bedside. I pulled away from him and said, loudly, "Don't you ever put your hands on me again; that's completely inappropriate for you to touch me!" :angryfire After that I think he realized what he was doing and he apologized, and we went back to business as usual. (In case you're wondering, the patient did fine). The more I think about it , the angrier I become, and I really want him to be reprimanded for his inappropriate and intimidating behavior. If you were in my situation, what would you do? I am thinking of putting the incident in writing and giving a copy to his supervisor and my manager. I just don't think I should let this go away. After all, how many other times has he probably done this (or worse) to someone else? Thanks for any help you all can give me.

Hi to all you L&D nurses, I have a question for you. I am an RN, I work in PACU, and my husband and I are thinking about starting a family relatively soon. My question is, what is the full range of pain relief options during labor? You hear so much about epidural vs. natural birth, but I was wondering what the options are in between, and what are the associated risks to mom and baby. This may be a simplistic question, but honestly I don't remember much about L&D from school; it was an early course in my program and the whole thing is kind of a blur Thanks for any info you can provide!

BTW, to add to my last post, ASPAN dictates a maximum of two Phase I pts per RN at one time. If your facility is not abiding by this very important rule, I would look for other employment. You are really putting yourself and your nursing license at risk. On the other hand, my PACU does a lot of holding while patients wait for beds. If the patients are floor status, once they are out of Phase I, they move to a holding area, where we PACU nurses care for them with a 4:1 ratio. If the patients are ICU, we treat them as 2:1 as if they were in ICU.

I did the move from ICU to PACU 3 yrs ago, after 2 yrs in ICU. I haven't regretted it for a minute. You'll have to see for yourself, but I think of PACU as critical care without a lot of the harder parts (i.e. chronic pts, death and dying issues, chronic incontinence, etc, etc). Of course, PACU has issues of it's own as does any unit, but I find them much easier to deal with. For instance, we have a lot of holding and thru put difficulties, you deal with confused and sometimes combative patients, and of course you spend a good portion of your day on hold with the floor trying to give report. But if you are someone who likes to take care of fresh post-ops, PACU may be for you!

Here is a direct copy of the ASPAN position on RN staffing in Phase I PACU; this info came from the website: Position It is, therefore, the position of ASPAN that two licensed nurses, one of whom is a Registered Nurse competent in postanesthesia nursing, will be present in the Phase I Postanesthesia Care Unit whenever a patient is recovering from anesthesia. There is also further description of this postion (which is in the ASPAN "Standards of Perianesthesia Nursing Practice" book but not on the website), which further clarifies that "present" means in the PACU and NOT nearby in the OR or in pre-op, for instance. I did some research on this topic when I recently changed hospitals and found out that my new PACU was only using one RN and a tech on the weekends. We are also a Level One Trauma, so of course this situation was unsafe. I brought the standards to the attention of my NM, and now we are requiring 2 RNs at all times for Phase I! By the way, if you would like to see other perspectives on this issues, there are a few threads on the chat boards on the ASPAN website. The overwhelming majority feel that it is incredibly important to abide by this staffing standard. As for the discharge question, we do discharge outpatient surgical patients from our PACU as a rule. There is an outpatient surgery center, but if the surgeon wants to do the case in the main OR anyway, we get the patient in our PACU. The previous hospital I worked at had a short-stay discharge area, so I have worked both ways. In my opinion, it is much better to be able to send a patient to another area to do the discharge work. However, we do make our situation work, and have policies in place regarding d/c'ing pt's from PACU. Basically, we are required to have kept the pt one hour, they must meet a PAR score of 9, be taking PO without N/V, and have appropriate pain control. Then we send them home with a responsible adult. This also includes peds. For the record, I felt really uncomfortable doing this at first, but like anything, it becomes easier with experience. Just make sure you are following your hospital and units policies, and it should be possible to do a PACU d/c. Hope this helps!

Hi everyone! I just wanted to find out how many of you are planning on giving your boss(es) a holiday gift? If so, what?