Syhuggins

We recently had a patient in Endoscopy that needed to be tranferred to another facility and the anesthesiologist wanted to start a propofol gtt and transfer the patient to the Surgical PACU setting to await tranfer. Our hospital pharmacy medication management manual does not list PACU as a location permitted to manage a propofol gtt. The PACU staff has never had any formal education about managing this medication and the anesthesiologist are not consistently in the PACU suite. Considering that this is an anesthetic the question would be is this appropriate for the PACU setting? It's not like the ICU where intensivists are readily available. Are there facilities that permit PACU nurses to manage a propofol gtt? If so is anyone able to share their policy/protocol?

Stella phase I & phase II really location seven though hospitals often break out spaces as though they are. phase I & phase II are a state You should become familiar with ASPAN it will help you understand. And I've been in places where all post op patients are recovered and discharged from the same location. It works better than dragging it out by changing locations.

If your experience in management is not in nursing it won't be considered. Highly unlikely you'd find anyone to hire you as DON with only 5years experience and none of that as nursing manager. You have to work your way up thru the ranks and gain the appropriate experience. I'm a nurse manager in a community hospital making $100Kt.

PACU is not less stressful or physically demanding. I am a NM for a Perioperative setting and would say you should explore other options. I also have 10 years experience in NICU and that is a high stress job as well - it's a calling not for the faint of heart. Newborn nursery may be an option.

As a new nurse it is critical you understand the importance of using your nursing drug book. There are no stupid questions. As a PACU Nurse Manager I am concerned about the type of orientation you are receiving and the decision if any manager to hire a new grad into this speciality. Even in an outpatient surgical center setting you must have critical care experience in order to posses the understanding of how to care for the patients in this setting. Good luck in your endeavors. Read everything you can get you hands on about post anesthesia care.

:typingthanks so much for the information

i am a pacu manager taking the endoscopy unit under my supervision. can anyone share with me policy on patients with pacemakers &/or aicds? we seem to being running into this more frequently with the gastro md wanting to use cautery & have the nurses place a magnet over the device. problem: we are a small community hospital with no ep lab on site, the device reps are not being called to come in and interrogate the devices after the procedure!! i have great concerns for the safety of the patients once dischaged ~ we have no way of knowing if the device is functional!

it is not at all uncommon to receive that much medication for an egd or colonoscopy. the use of fentanyl vs. demerol is certainly a facility choice & administering 50 - 100 of either drug is common as well as, as much as up to 10mg of versed. the amnesia after the procedure is created by the versed & that is why it is used, but yes, patients are "awake" and following the commands of the staff during the course of the procedures. it is common and expected that the patients are discharged without memory of the procedure & typically will have that experience for the rest of the day! the addition of benadryl is something i've never seen in my practice, but again that would be a practitioner preference. the hangover you experienced is more likely associated with the use of the benadryl. to use propfol changes things ~ that means a costly trip to or for anesthesia to provide that level of sedation vs. using the endopscopy suites! completely unnecessary, especially when being able to complete the procedure with moderate sedation without difficulty. propofol should only be used for the patients that you are unable to provide enough moderate sedation to complete the procedure and again in that case must be done in the or.

I do not have a step down / Phase II PACU & so my nurses do it all - the patients come directly from the OR to this unit & are discharged to home (or the floor) as well. Our length of stay is now based simply on the Aldrete score. Condition based discharge is how we function & it has been quite a transition for my nurses who were discharging based on time limitations (i.e. the first hour was considered phase I & the patient was required to remain at that status for one hour & then they were considered phase II & sat for an hour, then & only then would they begin to think about offering the patient a drink & prepping them to go home). Perform an intenert search for the following article - it is very helpful if you are looking to change current practice: Discharge Criteria and Complications after ambulatory surgery If you would like to PM me your email address I would be happy to send you some article.