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    Protocol of Pacu

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    Maahi
    The document discusses protocols for patient care in the post-anesthesia care unit (PACU). It outlines that the PACU is where patients are monitored as they wake from anesthesia. It describes the purpose of the PACU as enabling safe and fast recovery through specialized care and monitoring by trained staff. The document then details specific protocols for patient transportation to and evaluation upon arrival in the PACU, continuous monitoring and evaluation of patients in the PACU, responsibility of physicians in discharging patients from the PACU, and criteria for safe discharge.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Protocol of Pacu

    Uploaded by

    Maahi
    219 views40 pages
    The document discusses protocols for patient care in the post-anesthesia care unit (PACU). It outlines that the PACU is where patients are monitored as they wake from anesthesia. It describes the purpose of the PACU as enabling safe and fast recovery through specialized care and monitoring by trained staff. The document then details specific protocols for patient transportation to and evaluation upon arrival in the PACU, continuous monitoring and evaluation of patients in the PACU, responsibility of physicians in discharging patients from the PACU, and criteria for safe discharge.

    Original Description:

    Surgery Presentation on protocol of PACU

    Original Title

    protocol of pacu

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    The document discusses protocols for patient care in the post-anesthesia care unit (PACU). It outlines that the PACU is where patients are monitored as they wake from anesthesia. It describes the purpose of the PACU as enabling safe and fast recovery through specialized care and monitoring by trained staff. The document then details specific protocols for patient transportation to and evaluation upon arrival in the PACU, continuous monitoring and evaluation of patients in the PACU, responsibility of physicians in discharging patients from the PACU, and criteria for safe discharge.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    219 views40 pages

    Protocol of Pacu

    Uploaded by

    Maahi
    The document discusses protocols for patient care in the post-anesthesia care unit (PACU). It outlines that the PACU is where patients are monitored as they wake from anesthesia. It describes the purpose of the PACU as enabling safe and fast recovery through specialized care and monitoring by trained staff. The document then details specific protocols for patient transportation to and evaluation upon arrival in the PACU, continuous monitoring and evaluation of patients in the PACU, responsibility of physicians in discharging patients from the PACU, and criteria for safe discharge.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 40

    SURGERY-2

    ASSIGNMENT
    TOPIC
    PROTOCOLS OF
    PACU
    INTRO (PACU)
    • Unit where patients wakes up after receiving
    anesthesia.
    • Vitals signs are closely monitered
    • Pain management initiated
    • Fluids initiated
    • Specialty area with trained staff Recovery from
    Anesthesia can range from completely
    uncomplicated to life threatening.
    • Must be managed by skilled medical and nursing
    personnel.
    • Anesthesiologist plays a key role in optimizing
    safe recovery from Anesthesia.
    • Must be carried out in a well planned , protocol
    based fashion.
    PAC
    • It is the specialized care given to the
    patients who have undergone anesthetic
    management, by a team of well trained
    proffessionals, in a specially designed ,
    equipped and designated area of the
    hospital.
    PURPOSE
    • To enable a successful and faster recovery
    of the patient post operatively.
    • To reduce post operative mortality rate.
    • To reduce the length of hospital stay of
    the patient.
    • To provide quality care service.
    • To reduce hospital and patient cost
    during post operative method
    PACU
    PACU
    PROTOCOLS
    • I - ALL THE PATIENTS WHO HAVE RECEIVED
    GENERAL ANESTHESIA, REGIONAL
    ANESTHESIA OR MONITERED ANESTHESIA
    CARE SHALL RECEIVE APPROPRIATE
    POSTANESTHESIA MANAGEMENT.
    1. A PACU or an area which provides equivalent
    postanesthesia care shall be available to receive
    pt after anesthesia care.
    2 .The medical aspects of care in the PACU shall
    be governed by policies and procedures which
    have been reviewed and approved by the
    department of Anesthiology.
    3.The design , equipment and staffing of the
    PACU shall meet requirements of the facility’s
    9/4/23 accrediting and licennsing bodies.
    • 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 MONITERING
    AND SUPPORT APPROPRIATE TO THE
    PATIENT’S CONDITION.
    • III - UPON ARRIVAL IN 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 & 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 responsiblity for the nursing
    care of the patient.
    IV - THE PATIENT’S CONDITION SHALL BE
    EVALUATED CONTINUALLY IN THE PACU
    1.The patient shall be observed & monitered by the
    methods appropriate to the patients medical
    condition .Particular attention should be given to
    oxygenation,ventilation,circuation,
    level of consciousness & temp.
    2.An accurate written report of the PACU period shall be
    maintained.Use of an appropriate PACU scoring system is
    encouraged .
    3. General medical supervision & coordination of Pt care
    in the PACU should be the responsibility of an
    anesthiologist.
    4.There shall be a policy to assure the vailability in the
    facility of a physician capable of managing complication &
    providing cardiopulmonary resuscitation for Pt in PACU.
    V - A PHYSICIAN IS RESPONSIBLE FOR THE
    DISCHARGE OF THE PATIENT FROM THE PACU

    1.When discharge criteria are used , they must


    be approved by the Dept of Anesthiosolgy &
    medical staff.They may vary depending upon
    whether the Pt is discharged to a hospital room,
    to the ICU , to a short stay unit or home.
    2. In the abscence of the physician responsible
    for the discharge , the PACU nurse shall
    determine that Pt meets the discharge
    criteria .The name of the physician accepting
    responsibility for discharge shall be noted on
    the record.
    PACU LOCATION
    • Should be located close to the operating room.
    • An open wards is optimal for Pt observation,
    with atleast one isolation room.
    • As it ensures that the Pt can be rushed back to
    surgery if needed or members of the operating
    room staff can quickly attend the Patients.
    • Immediate access to Xray , blood bank , blood
    gas & clinical labs & on the same floor
    • Centre nursing station must be present.
    9/4/23
    PACU STAFFING
    • One registered nurse to the Pt for the
    first 15 minutes of recovery (1:1)
    • Then one nurse for every two Pts.
    • The PACU should be staffed only by
    nurses specifically trained in the care of
    patients emerging from anesthesia.
    PACU EQUIPMENTS
    • Automated NIBP
    • Pulse oximetery
    • Thermometre
    • EtCO2
    • ECG
    • I V supports
    • emergency equipments,crash
    cart,Defibrillators.
    ROUTINE PAC
    • Criteria for shifting from OR to PACU.
    • Conscious,awake ,responds to simple
    commands
    • Hemodynamically stability
    • Clinical evaluation & complete recovery
    from NM blockade.
    • Maintainence of Oxygen Saturation.
    • Normothermia
    PHASES OF POST OP UNIT
    • Two phases:-

    • PHASE - I
    • PHASE -II
    PHASE - I
    • It is the immediate recovery phase and
    requires intensive nursing care to detect
    early signs of complications.
    • Receive a complete patient record from
    the operating room which to plan post
    operative care.
    • It is designated for care of surgical patient
    immediately after surgery and patient
    requiring close monitering.
    PHASE - II
    • Care of surgical Pt who has been
    transferred from phase I to post op unit.
    • Patient requiring less observation and
    less nursing care than Phase I
    • This phase is also known as step down or
    progressive care unit.
    LENGTH OF STAY IN PACU
    • Varies , depends upon several factors:
    - Type of Surgery
    -Patients response to surgery & anesthesia
    -Medical history
    • Average length of stay is 1-3 hrs.
    •Longer stays may be nescessary to meet
    discharge criteria.
    NURSING MANAGEMENT IN POST OP
    UNIT
    • To provide care until the Pt has recovered from the
    effect of anesthesia.
    • ASSESSING THE PT
    • Monitor vitals-pulse volume regularity,depth
    & nature of respiration.
    •Assessment of Pt O2 saturation.
    •Skin colour
    •protect airway
    •maintain IV stability
    •Keep the Pt warm
    •Relieving pain & anxiety
    Keep monitering vitals
    Check level of Consciousness.
    Ability to respond to commands
    Maintain intake & Output
    assesment of the Surgical site
    • HEMORRHAGE -
    - It is a serious complication of Surgery that
    can result in death.
    - It can occur in immediate post operatively
    or upto several days after surgery
    - If left untreated cardiac output decreases
    & blood pressure & Hb level will fall rapidly.
    POST OP COMPLICATIONS
    • Nausea & Vomitting
    • Respiratory Complications
    • Failure to regain Consciousness
    • Circulatory Complications
    • Fever
    Controlling Nausea & Vomitting
    • This is common problem in post op
    period.
    • Medication can be administered as per
    doctor’s order.
    • ex: inj Metocloprimde
    • inj Ondasetron
    Discharge criteria from PACU
    • Easy arousability
    • Full orientation
    • Ability to maintain & protect airway
    • Stable vital signs for atleast 15-30 mins.
    • The ability to call for help if nescessary
    • No obvious surgical complications (active
    bleeding)
    POST ANESTHESIA DISCHARGE SCORING

    • To discharge a patient from post anesthesia


    care unit to level II care unit, modified
    Alderete scoring is done.

    • MODIFIED ALDERETE SCORING


    - 5 Pramateres
    - Max 2 score for each parametre,max score
    is 10.
    -If max score >8, then shift pt to level II
    care unit.
    Post anesthesia Discharge Scoring
    system (PADSS)
    • Very important for day care surgery.
    • done when a patient is about to
    discharge.
    • It has 6 parametres.
    • If >9 - then only discharge patient.
    PADSS
    Safe guidelines for discharging to
    home after ambulatory surgery

    • Patient should be able to stand & take few


    steps.
    • Should be able to sip fluids.
    • Should be able to urinate.
    • Should be able to repeat poost - operative
    management.
    • Should be able to identify the ecort (cognitive
    function).
    VIDEO
    9/4/23

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