How frequent should the nurse monitor the vs of the patient in the recovery room?

Developed By: Committee on Standards and Practice Parameters
Last Amended: October 23, 2019 (original approval: October 27, 2004)
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These standards apply to postanesthesia care in all locations.  These standards may be exceeded based on the judgment of the responsible anesthesiologist.  They are intended to encourage quality patient care, but cannot guarantee any specific patient outcome.  They are subject to revision from time to time as warranted by the evolution of technology and practice.

STANDARD I

ALL PATIENTS WHO HAVE RECEIVED GENERAL ANESTHESIA, REGIONAL ANESTHESIA OR MONITORED ANESTHESIA CARE SHALL RECEIVE APPROPRIATE POSTANESTHESIA MANAGEMENT.

1.A Postanesthesia Care Unit (PACU) or an area which provides equivalent postanesthesia care (for example, a Surgical Intensive Care Unit) shall be available to receive patients after anesthesia care.  All patients who receive anesthesia care shall be admitted to the PACU or its equivalent except by specific order of the anesthesiologist responsible for the patient’s care.
2.The medical aspects of care in the PACU (or equivalent area) shall be governed by policies and procedures which have been reviewed and approved by the Department of Anesthesiology.
3.The design, equipment and staffing of the PACU shall meet requirements of the facility’s accrediting and licensing bodies.

STANDARD II

A PATIENT TRANSPORTED TO THE PACU SHALL BE ACCOMPANIED BY A MEMBER OF THE ANESTHESIA CARE TEAM WHO IS KNOWLEDGEABLE ABOUT THE PATIENT’S CONDITION.  THE PATIENT SHALL BE CONTINUALLY EVALUATED AND TREATED DURING TRANSPORT WITH MONITORING AND SUPPORT APPROPRIATE TO THE PATIENT’S CONDITION.

STANDARD III

UPON ARRIVAL IN THE PACU, THE PATIENT SHALL BE RE-EVALUATED AND A VERBAL REPORT PROVIDED TO THE RESPONSIBLE PACU NURSE BY THE MEMBER OF THE ANESTHESIA CARE TEAM WHO ACCOMPANIES THE PATIENT.

1.The patient’s status on arrival in the PACU shall be documented.
2.Information concerning the preoperative condition and the surgical/anesthetic course shall be transmitted to the PACU nurse.
3.The member of the Anesthesia Care Team shall remain in the PACU until the PACU nurse accepts responsibility for the nursing care of the patient.

STANDARD IV

THE PATIENT’S CONDITION SHALL BE EVALUATED CONTINUALLY IN THE PACU.

1.The patient shall be observed and monitored by methods appropriate to the patient’s medical condition.  Particular attention should be given to monitoring oxygenation, ventilation, circulation, level of consciousness and temperature.  During recovery from all anesthetics, a quantitative method of assessing oxygenation such as pulse oximetry shall be employed in the initial phase of recovery.*  This is not intended for application during the recovery of the obstetrical patient in whom regional anesthesia was used for labor and vaginal delivery.
2.An accurate written report of the PACU period shall be maintained.  Use of an appropriate PACU scoring system is encouraged for each patient on admission, at appropriate intervals prior to discharge and at the time of discharge.
3.General medical supervision and coordination of patient care in the PACU should be the responsibility of an anesthesiologist.
4.There shall be a policy to assure the availability in the facility of a physician capable of managing complications and providing cardiopulmonary resuscitation for patients in the PACU.

STANDARD V

A PHYSICIAN IS RESPONSIBLE FOR THE DISCHARGE OF THE PATIENT FROM THE POSTANESTHESIA CARE UNIT.

1.When discharge criteria are used, they must be approved by the Department of Anesthesiology and the medical staff.  They may vary depending upon whether the patient is discharged to a hospital room, to the Intensive Care Unit, to a short stay unit or home.
2.In the absence of the physician responsible for the discharge, the PACU nurse shall determine that the patient meets the discharge criteria.  The name of the physician accepting responsibility for discharge shall be noted on the record.

*Under extenuating circumstances, the responsible anesthesiologist may waive the requirements marked with an asterisk (*); it is recommended that when this is done, it should be so stated (including the reasons) in a note in the patient’s medical record.

After you have been discharged from Post-Anaesthesia Care Unit, you will be transferred to the Day Surgery Unit/Phase II Recovery. The goal of this unit is to provide patient comfort in terms of pain and nausea control. The patient and family will be given post operative information verbally and in writing, and will have the opportunity to ask questions.

1. During your stay in Phase II Recovery, you will be monitored by a nurse who will assess your vital signs every 30 minutes which will include:
   • Temperature
   • Blood Pressure
   • Heart Rate
   • Respiratory Rate
   • Oxygen Levels

1. Patient comfort in terms of pain control is a primary goal in Day Surgery/ Phase II Recovery. You will be asked to rate your pain in order to provide the nurse with the necessary information to tend to your needs.The pain scale we commonly use is rated 0 (no pain) to 10 (worst pain imaginable). The nurse will ensure that you are given proper pain medication. (Managing Your Pain pamphlet)
    
2. The nurse will be monitoring your surgical site. You will also be monitored for nausea and medicated accordingly.
    
3. You can expect to be in Phase II Recovery for at least 30 minutes.You may experience dizziness and be unsteady on your feet. Your care provider will need to assist you while walking and/or transferring from a lying /sitting position to a standing position.
    
4. You will be encouraged to drink fluids. You may be expected to urinate prior to discharge depending on the type of surgery you have had.
    
5. Family members or friends will be invited to be at your bedside.
    
6. Your belongings will be returned to you. Please ensure that you have received all the items you had prior to your surgery.
    
7. Post-operative instructions will be discussed with you and your caregiver, and any questions you may have will be answered.  We will also review the booklets and literature that you received in your Pre-Admission Clinic appointment.
    
8. You should have an appropriate caregiver stay with you for 24 hours following your discharge from hospital. Safe and acceptable transportation arrangements must be made. London Health Sciences Centre Discharge Policy
    
9. If you are traveling from out-of-town, you may be asked by your surgeon to find accommodations in London for the first post-operative night.
    
10. With any serious post-operative questions or concerns, call the LHSC switchboard at:

519-685-8500 and ask for the resident on-call for the surgical service
 

1. With any serious concerns, please go to the nearest emergency department

PATIENT DISCHARGE

Your family member or friend will be asked to get the car (or taxi) and pick you up..
 

For University Hospital:

• Patients should be met at the Security Desk near the emergency department doors.
• Bring your car to Zone A, enter the doors by security and ask the security officer to contact Day Surgery on your behalf. A porter will bring the patient.

Map for patient pick-up

For Victoria Hospital:

• Park the car and enter the "C" entrance door located near the Ivey Institute. angle parking is available.
• Turn right and locate the house phone.
• Call Day Surgery using the number listed by the phone.

Map for patient pick-up

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