FUNCTION:  Assessment of Patients

 

TITLE:  Discharge from PACU:  Criteria, Procedure and Report

_________________________________________________________________

 

PURPOSE:

 

To provide guidelines for discharge of the patient from the PACU.

 

POLICY AND PROCEDURE:

 

1.   The patient should be assessed by an Anesthesiologist, a Physician, or a

     Registered Nurse as follows in determining if he/she is ready for

     discharge from the PACU.

 

     A.   The Anesthesiologist will determine by written order what score on

          the Aldrete scoring system the patient must achieve before being

          discharged from the PACU.  If the anesthesiologist does not leave

          discharge Aldrete score, the patient will be dismissed with an

          Aldrete score of 10.  If the anesthesiologist cannot be reached, see

          policy concerning the Primary Physician - Clinical Management of

          PACU Patient.

 

     B.   General anesthesia patients should remain for a minimum of one (1)

          hour unless otherwise ordered by anesthesiologist.  Patient must:

 

          1)   Be awake and oriented to time, place, and person.

          2)   Able to lift head and hold up more than 30 seconds.

          3)   Vision clear without nystagmus.

          4)   Demonstrate bilateral firm hand grips and movement of all four

               (4) extremities).

 

     C.   Local anesthesia patients should remain a minimum of 30 minutes and

          be free of shortness of breath, urticaria, facial edema,

          hypotension, or other signs of adverse reactions, or unless

          otherwise specified by physician.

 

     D.   Patients receiving spinal anesthesia and being sent to post recovery

          area must be evaluated for complete dissipation of anesthesia prior

          to transfer.  Patients receiving spinal anesthesia and being sent to

          observation room must meet the following criteria:

 

          1)   Sensory level of T-10 or lower.

          2)   Able to bend their knees.

          3)   Or as specified by anesthesiologist's written order.

 

     E.   Patients receiving regional anesthesia, i.e. brachial block, should

          remain a minimum of 30 minutes to allow for neurovascular checks. 

          Care should be taken to protect the extremity from harm until full

          function is restored.

 

     F.   Patients less than 10 years of age may be discharged from the PACU

          after 45 minutes if:  awake and alert, vital signs stable, an

          Aldrete score of 10 has been reached, and a responsible adult family

          member is present.

 

     G.   Patient must have an oral temperature of 96 F or its equivalent

          rectally, or axillary prior to discharge from PACU.

 

     H.   A minimum of 90% of SaO2 on room air should be reached.

 

     I.   PACU discharge instructions for patients who have received any

          medications in PACU refer to the policies concerning routine PACU

          care.

 

     J.   Exceptions to the above should be made only on the order of the

          responsible physician.

 

2.   Procedure for discharge.

 

     A.   IV's should be kept open or infused as ordered.  If the IV is 200cc

          or less, then the next ordered IV will be sent with the patient and

          noted in orders.  If no further IV orders exist, a 500cc bag of the

          IV may be sent.

 

     B.   Dressings should be inspected.  Any reinforcement or dressing change

          necessary will be done before patient leaves PACU.

 

     C.   Any drains will be emptied and/or compressed.

 

     D.   Patients may be dismissed when fully awake, free of vertigo, vision

          clear, and nausea and vomiting absent.

 

     E.   Documentation of closing assessment will be made on the PACU record.

 

     F.   Call report to receiving unit - see PACU Policy titled "PACU Report"

          (see #3 below).

 

     G.   Patient will be transported via stretcher, bed, or wheel chair to

          the receiving unit by at least one licensed personnel.

 

     H.   Post-operative instructions to patient and family may include

          activity and medications as ordered by physician.

 

     I.   The receiving unit will be notified of the patient's arrival by the

          transporter.  If the patient needs to be transferred from a

          stretcher or wheel chair to a bed, a second person must be able to

          assist with the transfer.  A licensed nurse from the receiving unit

          must sign the PACU record at the time of transfer, accepting

          responsibility for the patient, any special equipment, dentures,

          belongings, and/or medications, as applicable.

 

3.   Upon discharge from the PACU to a room, a verbal report must be given  to

     the receiving unit.  Said report shall include the following:

 

     A.   Patient's name, and name of surgeon.

 

     B.   Post-op diagnosis.

 

     C.   Procedure done and type of anesthesia; i.e., spinal, regional, or

          general.

 

     D.   Vital signs while in PACU:  include ranges of B/P, pulse

          respirations, the last temperature, and SaO2.

 

     E.   Neurovascular status for all patients with casted limb or limbs with

          restrictive dressings.

 

     F.   Neuro check status for all known or suspected neurological cases.

 

     G.   I.V. solution presently infusing; time due down, any additives and

          if further I.V. therapy is ordered, rate/hour and site must be

          stipulated.

 

     H.   Presence of drainage tubes, appearance of drainage, and how

          connected.

 

     I.   Status of dressings, cast, etc.  Presence of drainage with estimated

          amount.

 

     J.   Intake and output in surgery and during PACU stay.  Include

          estimated blood loss during surgical procedure.