Cschroy1

How do you all feel about mixing pre-ops and post-ops in PACU? Is there an ASPAN standard for this? I looked in the 2008-10 book and couldn't find it. I work in a tiny 5-bed PACU and we have inconsistancy among our nurses allowing the OR team and docs to bring in pre-ops for their convienience all the while we have a phase I PACU pt recovering behind a curtian in the same room. Some don't see it as a big deal if you pull the curtain, others are more strict. My main question is what do the standards say? Should we allow it to happen in extreme cases(i.e. no where for the pre-op to sit and wait for OR.) Let me know your thoughts! Thanks!

I would def recommend some type of critical care classes. Working on the floor has probably given you excellent time managment skills. In the PACU, you will most likely ever have 2 pt's max- so that will be easier, but on the other hand- they require more intense care. Phase 1 PACU is considered critical care, so those classes would def help! Good luck and congratulations!

I did find this statement by ASPAN that I thought may be helpful as well on answering your question: "Phase I PACUs are by their nature critical care units, and as such staff should meet the competencies required for the care of the critically ill patient. These competencies should include, but are not limited to, ventilator management, hemodynamic monitoring and medication administration, as appropriate to their patient population." I found it here: https://www.aspan.org/Portals/6/docs/ClinicalPractice/PositionStatement/8-Joint_ICU_Overflow.pdf Hope that helps! :)

Thanks guys for resonding! I enjoyed reading your comments. To clarify for Southern Fried RN: 1) I def think PACU nurses are competent. I would say that it depends on the individual nurse! I've worked with some not-so-smart ICU nurses and then some outstanding PACU nurses... the whole gambit. It depends on the unit, the pt population and the experience level of the nurse. 2) The reason I said they would be more competent is b/c they probably see those issues more. Our pt's in PACU are in and out. ICU pt's LOS is longer, hence the ICU nurse may see those issues arise more, plus ICU pt's are usually sicker. 3) I am really talking specifically about our hospital, but was curious if you all felt the same way about your hospitals. Hope this helps with the clarification! If not, let me know! Okay so I got to thinking.... What if PACU just took every post-op pt no matter where the destination(including ICU). What, if any disadvantages would there be to the pt and unit? I thought of 3 so far.... 1) extra cost? 2) need to repeat tests- ABG/CXR (r/t bumpy elevator ride). 3) Pt is usually sedated pretty well when they first arrive(good for PACU) and start to wake up more when they reach the ICU 30 min later(bad for them) and leaves nurses scrambling for medication/orders. Oh, and 1 more question- what is the average time you all keep your ICU's pt's in PACU? Tell me what you think! Thanks!

Why would an ICU pt go to PACU? Unless obviously there is no bed/staff and PACU is holding until a bed/nurse opens. But what if there IS a bed? My question is why would an intubated, sedated ICU pt make a pit-stop in the PACU to be recovered when there is nothing to recover? Why not go straight to the ICU when the plan is for them to go there anyway and the ICU has known about the admission for hours? I can understand if there is no nurse or bed at that time, but someone please help me understand why ICU nurses dont want to take a pt directly from the OR? I would think that an ICU trained nurse would be more competent to deal with issues such as hemodynamic instability, resp. compromise and fluid status. I worked SICU for 5 years and we took pt's straight back if they were scheduled to come to ICU intubated or not. Now I work in a 5-bed PACU and the 20-bed ICU is refusing to take pt's back until they spend "some time" in the PACU- how can they do that? We use the Aldrette scoring and can discharge a pt with a score of 9. An ICU pt would never attain that score! Many ICU's admit pt's straight from the ER- why is the OR any different? Is the PACU better equipped to take fresh post-op ICU pt's? I know ASPAN doesn't really take a stand on this issue- every hospital is different. I would really be interested in hearing other nurses comments on this issue. Please help! Thanks!