Guidelines address staffing in phase III

Justify your post-op numbers

Same-day surgery managers now have guidelines available to establish nurse/patient ratios in the phase III setting. (See copy of the guidelines, enclosed in this issue of Same-Day Surgery.)

The guidelines, which were developed by the American Society of PeriAnesthesia Nurses (ASPAN) in Thorofare, NJ, have been added to guidelines for the phase I and II areas and can be used to justify the presence of staffing in postoperative areas. (For more on staffing in phases I and II, see SDS, November 1997, p. 146. For AORN staffing formula for the OR, see SDS, October 1997, p. 129.)

Phase III is for extended observation

The phase III standards were written for patients who have completed phase I and phase II recovery but might need extended observation, says Ellen Sullivan, BSN, RN, CPAN, director of clinical practice for ASPAN and nurse in charge of the postanesthesia care unit at Brigham and Women’s Hospital in Boston.

"Or it’s for persons who develop entrepreneurial ideas and open a bed and breakfast or a freestanding [postsurgical recovery care] unit that might keep patients until the next day who really have recovered but need observation or pain management before they go home," says Sullivan.

The guidelines also say phase III staffing guidelines apply to patients waiting for transportation home and those who have no caregiver.

According to ASPAN, staffing in phase III is dictated by patient acuity. This advice is echoed by Dorothy Fogg, RN, BSN, MA, perioperative nursing specialist at the Center for Nursing Practice, Health Policy, and Research at the Denver-based Association of Operating Room Nurses.

"If I have some patients with comorbidities, such as a diabetic coming in for cataract, I’d consider that," Fogg explains. "I’d make sure I have a nurse to devote extra time to that patient."

As a guideline, ASPAN says there should be one competent RN for at least every five patients. These guidelines, along with the guidelines for phases I and II, can be used to justify staffing in postoperative areas.