PACURN1956

Our criteria for spinal anesthesia is based on hemodynamic stability, patient not requiring medication for hypotension in past hour, and the patient must be able to turn their upper body to protect their airway. In the 15 years I have worked in PACU I have seen our standards change from set in stone same for every patient to a policy that is dependent on the patient meeting criteria. We do not have to wait for the spinal level to move a set number of dermatomes or be able to move toes as it was in the past. As our volumes have increased we would not be able to house all our postop patients if we were still waiting for the old standards.

I work in a large hospital PACU where we recover everything except NICU patients and Open heart surgeries. We also do elective cardioversions, blood patches and in the past did ECT's but our psych MD's have moved away from those. Although we do see some of everything Meandragon mentioned, it is not on every patient every day and as most PACU nurses will tell you often it is the routine simple surgery that can have the worst outcomes. Three of the 4-5 deaths I have seen in PACU were perm cath insertions. The wonderful thing about PACU is that every patient is something different and while you may work your tukkus off one day, the next may run smooth as clockwork. In my facility the relationship between PACU nurses, anesthesiologists and CRNA's is one of trust and cooperation. It is without a doubt the best place I have worked. I would encourage you to shadow a nurse in PACU and see if it is for you. There is a reason PACU turnover is so low.

I work in a 700+ bed hospital that has been using insulin pens for several years. It has been recently announced that the pens will be discontinued because of rampant misuse of the pens by the nursing staff. I was mortified to learn that pharmacy was able to track one pen being used on over 100 patients. I work in a unit (PACU) where we still draw up insulin from a multiuse vial. I could not believe that this is occuring so frequently and apparently by the same nurses over and over again. I do not know if the patients involved are being informed but I do know that the nurses involved are still working. When I voiced my shock I was told that this error is occuring in hospitals everywhere. Am I crazy in thinking that every nurse should know this is unsafe and immoral, dare I say criminal behavior? Now I am being told that mass education will be needed for the switch back to multidose vials because nurses don't know how to draw up insulin, some have been caught using 3ml syringes. What is going on? It has been many years since I was in nursing school but geez this is kind of basic stuff. If nurses are so careless about something as basic as this, what is going on with more complicated skills? I am interested to hear from hos