Clinical Protocol Page 1 of 3 JDH Postanesthesia Care - Unit Practice Manual John Dempsey Hospital – Department of Nursing University of Connecticut Health Center

PROTOCOL FOR: Extended PACU Stay

POLICY

1. When inpatient hospital beds are full, perioperative nursing

management, in collaboration with anesthesiology and surgery, will determine a plan to maintain flow of the surgical schedule.

2. After the patient has achieved criteria for discharge from PACU and has been signed out by Anesthesiology, the admitting service assumes all medical responsibility for the patient, including generation of all medical orders.

3. Patients prioritized for transfer out of PACU to an inpatient unit

include those:

a. on radiation precautions b. ICU/critical care patients

c. on CIWA protocol

d. on Restraints protocol

e. on seizure precautions

f. on aspiration precautions

g. who require 1:1 or constant observation care

h. with sickle cell diagnosis

i. with specialized teaching needs

4. Nursing Staffing Office will assign extended stay patients to

virtual beds in the Bed Management System to facilitate admission and associated orders. Patient admission packets will be provided to patients, as needed.

5. Staffing for extended stay patients will be done by PACU on-duty/on-call staff and augmented by additional staff assigned by the Nursing Office. A back-up call RN will be assigned to cover emergency surgical recoveries. Staffing ratios for extended stay patients will match those required on the inpatient unit to which the patient would be transferred. Ancillary and support service staff needs will be included in the staffing plan.

6. Pharmacy will verify all medications during the extended stay and will deliver medications and the MARs to PACU. Medications will be secured in the locked bedside medication safes. Documentation of medication administration will be done manually on the MAR.

7. Documentation for extended PACU stay patients will be done in a combination of SIS and paper documentation. Observations will be recorded on a frequency per vital signs orders; patients on capnography will remain on telemetry and observations will continue to be recorded in SIS while the order is in effect. a. SIS PACU interim, extended stay, and/or discharge wizards, as

appropriate, plus post-anesthesia sign out reassessment of Integumentary and Fall Risk

Clinical Protocol Page 2 of 3 JDH Postanesthesia Care - Unit Practice Manual John Dempsey Hospital – Department of Nursing University of Connecticut Health Center

PROTOCOL FOR: Extended PACU Stay

b. Inpatient Database – initiate sections for:

1) Elimination: urinary and bowel concerns 2) Discharge Planning

3) Nutrition Screening

4) In-house Services

*Complete entire Inpatient Database within 24 hours.

c. Refer to SIS Preadmissions and Holding documentation for baseline

status on:

1) Integumentary 2) Cardiopulmonary

3) Fall Risk

4) Vascular Access Devices

5) Vaccination History

6) Smoking History and Cessation Education

8. Additional equipment and supplies needed for inpatient use will be

obtained as needed. Call bells and proximity to patient bathrooms will be considered when assigning PACU bays to the patients; bays closest to the preop holding area will be assigned preferentially and will be grouped in close proximity to provide appropriate nursing care.

9. Physical therapy will be done as ordered. Page physical therapist charge beeper to notify service of patient’s location. Confirm surgery performed and equipment needed to facilitate process.

10. Diet needs will be addressed by faxing appropriate diet order to the Dietary Office before 6:30pm.

11. Patient and family teaching will be documented on the Surgical Admission: General Teaching Record. It will be augmented by using a combination of Care Notes and other on-line resources, as appropriate. Smoking Cessation and CHF handouts will be used, as indicated, to promote compliance with CORE measures.

12. PACU staff will refer to Extended Stay unit binder details for any patient in Restraints or on the CIWA: Alcohol Withdrawal Assessment protocol. ACU RNs will refer to binder for details regarding administering pneumococcal and/or influenza vaccinations to any unvaccinated patient who will be discharged directly from the PACU.

DESIRED PATIENT

OUTCOME: 1. Surgical patients who have an extended PACU stay will receive the

same standard of care as provided by inpatient units.

Clinical Protocol Page 3 of 3 JDH Postanesthesia Care - Unit Practice Manual John Dempsey Hospital – Department of Nursing University of Connecticut Health Center

PROTOCOL FOR: Extended PACU Stay

PATIENT AND

FAMILY EDUCATION:

Family will be oriented to the unit and restrictions on visitation. Patient and family will be updated on transfer or discharge status.

APPROVAL: Nursing Standards Committee

EFFECTIVE DATE: 11/1/10