Questions About Your PACU

All4Seasons · Mar 4, 2010

Hi again,

I just now realized how awfully long my question list is! :eek:

If you want to answer just one question that's totally fine -I'll be happy to have any and all responses.

Thanks! :redbeathe

bmcdeb · Mar 9, 2010

We face the same issues in our PACU. And are currently looking for alternatives to help move the patients through more efficiently, but safely.

One of the projects we are undertaking is initiating faxed or electronic reports to the floors...just beginning with this. We spend so much time on hold waiting for the floor nurses to come to the phone!

To answer your other questions:

We do place the appropriate pump tubing on all patiets, all our fluids are admin. via pumps in here. We do not hang the ordered postop maintenance IV's esp. if they have KCl in them, as we do not generally transport with the fluids on the pump...unless of course they are monitored/receiving kcl replacement.

Our nurse/patient ratio is 1/2.

We do computer charting.

We do give warm blankets to everyone.

Minimal temp to leave is 96.8F or 36C

We are primarily an inpatient PACU. Our hospital has a same day surgery center on site...HOWEVER, we do often get daystay patients who need to be discharged. since we don't have a phase 2 area, they stay in the main pacu and are fed, dressed and discharged from here. This is also consumes alot of nursing time that could be used recovering phase 1 patients. We have limited space here. The daystay unit is not open on weekends or holidays either.

There is not a consideration as far as I know for MRSA or VRE patients as far as the time of day they are scheduled. We usually do the scheduled early morning admissions first, then inhouse addons later...depending on the urgency of the case of course.

We are not supposed to have any beverages in the unit...

Personal calls are not a huge issue, everyone seems to be pretty reasonable with them. Occasionally we have someone who needs to be reminded to keep them to a minimum. They are allowed within reason.

We have hired some novice nurses here( just a few years med-surg experience), but find that the best fit for our unit usually comes from ICU or Intermediate Care Rn's who know cardiac rhythms/emergency meds and are used to handling complex patients. We care for all cases except the open-hearts. (we have a separate unit for pedi patients during the day until 6pm, then take those patients at night and on weekends also)

A few novice nurses have had the personality and adaptability to work well here. Some have required extensive orientation and still are not at ease with the heavier cases.

Hope this is helpful!

MsBruiser · Mar 9, 2010

There are some ongoing issues in our PACU about pt flow into and out of the unit due to that perpetual bottle neck that PACU is. We are caught between the surgeon's need to do her/his work on pts who need their surgeries,and the short-staffed floors who are struggling to manage pt flow in their units so that they can accomodate the fresh ORs we'd like to send them. We have some disagreement about what should be included in the care of a pt in PACU and what is the receiving floor's 'fine tuning'.
I'd like to know what the general consensus is in your unit regarding these questions (a few of these are just feedback questions):
1.) Do you hang the IV solution ordered by the service for the floor, or the NS or RL that are considered "our" solutions (as one anesthetist here put it)?
If time permits - depends on the nurse. I try and do it.
2.) Do you hang infusion pump tubing on anyone's/everyone's IVs?
See above. I change the tubing.
3.) What is the nurse to patient ratio in your unit? (the general rule of thumb)
Phase I 1:2
4.) Do you computer chart?
Not yet
5.) Do you give warm flannels to all pts on arrival?
If time permits. If everyone is busy a single RN cannot often breakaway to get blankets. 80% of time, yes.
6.) What is the accepted minimum temperature for discharge from your unit?
36 celsius
7.) if you discharge a pt (who meets the criteria for discharge) to Phase Two and they become nauseated,are they returned to you in Phase One for iv antiemetics?
Given in Phase II
8.) Mon-Fri when does your Phase Two close for the day? Do you then, in PACU, do the discharge teaching,dressing,arranging rides,etc?
Depends.
9.) is Phase Two open on the weekend in your facility?
PACU is shut except for on-call cases.
10.) How are your cases who are MRSA or VRE carriers scheduled? are they done late in the afternoon/evening (when PACU staffing is tightest) or has something else been thought of at your facility?
Please...mixed in with everyone else.
11.) Is it frowned on in your unit to have a cup of coffee/tea/water with you in the unit?
No...just be discrete.
12.) Are personal calls from family an issue in your unit? allowed within reason/forbidden unless emergency?
Not that I know of...as long as it is within reason I can't see any problem
13.) Do you and your colleagues feel supported by your manager or do you feel she is a mouthpiece for administration?
'Nuff said.
14.) Do you hire novice nurses? If so,how well is this working?
Works best with critical care background.
We'd really appreciate your feedback. Thanks! :)

Hope this helps.