When is it safe for a pt to come to the floor from recovery?

RNsRWe, ASN, RN · Jul 22, 2008

Kind of a gray area; our post-ops have to be responsive, but they are sometimes "fuzzy". Sounds like this one was a bit more lethargic than she should have been, though. I want them awake enough to know what the heck is going on around them.

Tash4nvyblues, RN · Jul 22, 2008

I don't think I would have sent the patient back. But I tell you what, it's obviously been a while since I have worked in an acute setting, because I would have never have been allocated such a large workload as what you had on that shift. Is this a normal workload for most in the acute areas.

Med Surge 2 · Jul 22, 2008

6-7 is normal, though 7 is hard. Staffing states that we should take 8, but I will only do that rarely and keep a log about when I do. 8 is when you have a couple stable lap chole's, lap appy's, anticipating discharge. Not when you have 72 year old colon resections.

litbitblack, ASN, RN · Jul 22, 2008

And that is on days. **** I wouldn' t take that much

Dolce, RN · Jul 22, 2008

In your circumstances I would have taken the patient and notified my charge that I needed help and that the patient was complex. There does not appear to be anything in the patient's assessment that you have described that is a contraindication for PACU discharge. Not all patients are able to transfer from stretcher to bed independently after surgery. I work in pre/post op and have never, ever sent a patient back to PACU. I have transfered patients to a higher level of care but never sent them to PACU. PACU is not a holding area. If the patient needs a higher level of care and they have been discharged from ICU then you need to contact the doctor and get them transfered.

lpnstudentin2010, LPN · Jul 22, 2008

When I am sleeping. lol. In reality, I am, I am still sleeping when they move me. Usually they have woken me a couple of times, but I go right back to sleep. The first thing I really remember except opening my eyes for a couple of seconds is waking up in my inpatient bed.

RN34TX · Jul 23, 2008

I sent this one back. 72 year old F lap colon resection. VS 100/58, 98, 12, 97.3 responds slugishly after much prompting to voice. Can't move from stretcher to bed. Moves arms then seems to forget what she is doing.
My 7th pt, 3rd post op. Said No. I have a blood pressure machine with pulse ox. No cardiac monitor. And I can't stay with her continuously.:argue:
Recovery was not amused, when I said don't even bother putting her in the bed she's going back down.
Oh, Report said AAO x3, EBL 450, Hx: HTN, Asthma, PVD

As a PACU nurse, I'm sure they weren't amused but I wouldn't beat you up over it. You need to do what your nursing judgement tells you is safest.

With the limited info you provided, no this patient should not have been sent back to PACU. Only if the patient becomes in need of ICU level care should she have gone back to PACU.

Having said that, what was her baseline? BP 100/58 and HR of 98 does not necessitate a monitored bed situation in and of itself but.....what if her normal BP were much higher and her HR much lower? Then are we looking at volume/blood loss issues?

Even so, those issues in and of themselves can be handled in a med/surg setting. I've had med/surg nurses who think that if a patient needs a blood transfusion or fluid that they need to stay in PACU and/or go to ICU.

Not so.

We usually correct those issues in PACU but yes, a patient can go to the floor with a bag of blood hanging with the second unit to be given by the med/surg RN.

However, I say that in a sense that the med/surg nurse has a safe ratio of patients to be able to handle it. 7 patients period is not safe for the med/surg setting and having 3 of them be fresh post-ops makes it even more unsafe. No way.

If that patient were mine in PACU and normally had a BP of say 140's systolic and a heart rate of 60 something and still sleepy, then yes I would have hung on to her for a while before transferring her to the floor.

But assuming that those vitals you mentioned were close to her baseline, I think that it is your patient load that is in question of safety rather than the individual patient from PACU.