shellabelle

Yes. I work in a hospital that does general, pediatric, and women's surgeries.

Most of the patients that have light/conscious sedation or just local anesthesia(such as a carpal tunnel release) bypass ph. I. The rest of our Ph. II patients are people who have recovered from "heavier" forms of sedation. We do not have a separate area to board our patients we hold for rooms. They are just taking up a slot in our recovery room. We do try to move them to the back side of the room so we can pull curtains and let family members back for short visits. We do not let any of our patients get out of the stretcher while in PACU unless we are discharging them ourselves. And that is only to go to the bathroom after they are fully recovered and to get dressed. It is the same in our Day Surgery/phase II area. They are less strict on staying in bed in the Phase II area, but we don't keep recliners in any area but admitted pt rooms. So, the patients are more comfortable staying in the bed than getting into one of the hard chairs. Patients aren't allowed to walk around in the Phase II areas unless going to the bathroom or getting ready to leave. We let them walk enough (with assistance) to assess gait and make sure they are stable enough to go home and get around(or not). It is very rare for a patient to come to us from the OR with oxygen on at all. The only times they have O2 on are: a) they are still intubated with an ETT, but not with an LMA, b) they have some sort of severe respiratory problem such as SEVERE sleep apnea/COPD, or c) they have had an ERCP and are coming from special procedures, which is a much farther trip than the OR. We do frequently have oral or nasal airways in place, and if they know we will need a face mask instead of a NC the circulator will call into PACU from the OR. There are only a couple of CRNAs that we frequently have problems with patients not wanting to breathe. We OCCASIONALLY have to hold an airway for a short period of time or have to change from NC to face tent b/c a pt can't maintain their sat. We generally don't have problems with our patients' airways, though. Of course, the first thing we do for any patient coming to us is put on O2 at 3-4L NC. That works for us, though. It just depends on the anesthesia styles/practices of each hospital.

love those!

any joint replacement, spinal surgery, open belly surgery(minus open appy), crani, or large patients should come out on a bed. any kind of hip surgery(even closed reductions) should come out on a bed. any patient that will be discharged or patients with more "minor" procedures can come out on a stretcher. It is always nice to bring a patient that has had a spinal block on a bed...we don't like hurting our backs to pull dead weight over to a bed :)

We recover all women's surgeries except for breast augmentations. This includes general or spinal c-sections, D&C, LEEP, PPTL, hysterectomy, breast reductions, and a smattering of other surgeries. The only postpartal patients L&D recovers are lady partsl deliveries.

Our MDs write in their orders, To PACU, then admit to floor/day surgery or write a D/C order when we discharge from PACU. We also have a PACU Protocol that has orders for pain meds, nausea meds, oxygen, and says at the bottom DISCHARGE FROM PACU WHEN CRITERIA MET. We have the anesthesiologists sign packets of them at a time and keep them in folders so they don't have to write/sign individual orders. We also go by the Aldrete system. These have worked well for us and we have never had any problem.

We recover alot of ACDF pts in my PACU. I have personally only seen 2 "go bad" and have to return to surgery for bleeding puposes. These were both in a short period of time, and the doctor stopped prescribing Toradol as a result. We have not had a problem since(it has been 2 years). One of the doctors has us monitor the patient for 2 hours in pacu, while the other two let us discharge to the floor when we feel they are ready. The biggest things to watch for are airway issues (have them swallow while touching their throat to check tracheal deviaton), neuro response(do a full neuro assessment), and making sure their vocal cords are intact. The doctors want to know if they can say "eee" and if they are moving everything as soon as they come to the bedside. We generally send all of our ACDFs to the floor on 2LNC. If we do not send the patient on O2, we make sure there is a prn order for one in the chart and that there is a flowmeter in the patient's room. Pain control is another issue many times. It is not uncommon for us to give the entire PACU protocol to chronic painers. Our protocol is total: 250mcg Fentanyl, 10mg Morphine, 50mg Demerol, and 25mg Phenergan all IV. However, one of the doctors has an order for 75-100mg Demerol and 25mg Phergan IM. This seems to work better than anything I ever give IV. We give the Demerol/Phenergan IM, then 50mcg Fentanyl IV and the patient calms down and reports pain control. I have never had to give more narcotic to a patient that I have given this coctail to. Many times the patient will have the same symptoms they were having preop (pain/numbness in arms or hands) and this is completely normal. The nerves were probably pinched for quite some time, and it takes time for the feeling to become normal again. We often have to reassure patients because having the same symptoms scares them and makes them think the surgery was unsuccessful. Make sure you check the H&P for preop symptoms, because new symptoms need to be reported to the doctor.

I started in PACU as a new grad, and did fine, but it is not for everyone. You need to be able to work in a high paced, high stress environment and MUST BE TEACHABLE. It is not a place for people who get stressed easily and do not pick up on things quickly. It is a critical care area in a non-ambulatory hospital. Ambulatory PACUs are not as critical, but still have critical elements such as airway difficulties, potential for ekg changes, and postop bleeding issues. If you do decide to work here, make sure you have a proper orientation. Don't just hang back and watch. Jump in and do not be afraid to ask questions. It is imperative that you understand what you are doing because things can go bad in a very short period of time. Like I said, I did fine, but there was another new grad starting with me that did not fair so well. You might look into shadowing a nurse for a few days to make sure this is a right fit for you. Good luck!

i swear, a class in crna school has to be Tangling Lines 101, and when they get bored with their magazines/sudoku/crossword puzzles, they try to invent new and more interesting knots.

My unit is a phase I unit with a phase II unit in a separate area of the hospital. We generally recover all surgical patients except for those only requiring sedation analgesia. We also recover non-surgical patients that require general anesthesia, such as an MR patient having an MRI. The surgeons do not separate their outpatient and inpatient surgeries. They do typically try to operate on a patient that will be discharged earlier in the day. We don't generally have problems with the separate units unless there is a heavy surgery schedule and we are bombarding Day Surgery(the phase II units) with patients. We also have problems when we are having to hold patients in PACU because there are no floor beds available. I have never worked in a combined phase I/phase II unit, but I like the fact that our phase II patients have a separate place to go because it clears a space for other patients. One downside for me is the fact that the day surgery unit closes before surgery and pacu close. We may still have surgeries working "after hours," so we are responsible for recovering and discharging them while caring for patients that are being admitted. Our staff is cut from 8 or 9 nurses to 1-3 at night. Depending on how busy our evening surgery schedule is, this can be very time consuming. The night nurses are responsible for the general hospital and women's hospital recovery rooms, so discharging a patient stretches the nurses and the(one) tech thin. My hospital's phasing guidelines are pretty straightforward. We are required to keep every patient (pediatric or adult) for at least 30 minutes. The pediatric patient has to be able to maintain an airway and be arousable (our saying is, "see eyes and go.") This is only for pedi patients younger than 4-5 years. Older pedi patients and adults have to be able to maintain an airway and must be awake and/or back to their preop condition. The patients may be sleeping when they are changed to phase II, but they shouldn't be in a sedated sleep. You generally do not want them confused unless that was their preop condition. Their pain should be at a tolerable level or controlled by an epidural or pca(pts going to the floor only). Except for rare circumstances, the patient must be off of oxygen to send them back to Day Surgery. It is ok to sent a patient to the floor with oxygen, but you cannot have any kind of airway in(oral OR nasal). You must feel comfortable with them being in a less monitored environment(nurse is not staying at the bedside). We keep our patients in a phase I status until we feel that they are ready to go to the floor/day surgery. There is additional criteria for a patient that had a spinal. The spinal must move down 2 levels if above T12 OR move at least one level to reach T12 OR move one level below T12 if that is where the spinal was initially assessed upon arrival. Basically T10 or above, it has to move 2 levels, T11 or below, it has to show progression. If you are unable to assess the spinal(ie alzheimers/dementia) or the spinal is not moving, the patient must stay in recovery for 2 hours with close airway monitoring. No phase I patient is to be left in a room without the supervision of at least 1 RN. Our Nurse to patient ratio for phase I is 1:2/3 unless there is an ICU patient (1:1). Our nurse can have up to 5 phase II patients(without any phase I patients). I hope this was helpful.