Your Liability in the Post-Anesthesia Care Unit (PACU)

The PACU nurse holds great responsibility for the care and safety of patients recovering from the effects of anesthesia and must do so in the absence of constant physician involvement. From the moment a patient is "accepted" into the PACU, the nurse working in this area must be exceptionally observant and vigilant, for even the slightest change in condition may trigger the need for immediate intervention. These guidelines can help:

    I make sure to review the post-op status of my patients upon admission to and discharge from the PACU.

My documentation includes a record of:

    vital signs

    level of consciousness

    IV fluids administered

    all drugs given

    physician PACU visits

    any unusual occurrences or post-op complications

    position of patient

    condition and color of skin

    circulation

    condition of dressing

    type and patency of drainage tubes, catheters, and receptacles

    amount of type of drainage (if difficult to measure, you might consider comparing the size of the drainage amount to a coin: quarter, dime, etc.)

    muscle response and strength

    level of comfort

    A physician is responsible for writing a discharge order for patients leaving the PACU.

    Any patient receiving other than local anesthesia on an ambulatory basis is accompanied at discharge by a designated adult who is responsible for the patient. This "responsible adult" should not be a cab driver or other hospital employee providing transportation service. The person should be an individual who intends to accompany the patient into his or her dwelling and remain there for a sufficient time.

    I keep the patient's family notified of the patient's well-being.

    I receive continual updates of the best methods for dealing with the following PACU risks:

    airway obstructiopatient falls

    aspiratioheart failure and stroke

    cardiac arrest malignant hyperthermia

    hemorrhage positioning and restraining injuries

    evisceration

    I avoid or am extremely careful when using the microwave to heat hot pads.

    I always protect the patient's skin from direct contact with ice packs.

    I periodically check hot pads and ice packs to prevent burns and frostbite.

    Any valuables arriving with the patient are carefully stored and returned to the patient's care unit upon his or her discharge from the PACU. We are especially careful when handling patients' dentures.

    Our unit has current standards from the American Society of Anesthesiologists (ASA) and the American Society of PeriAnesthesia Nurses (ASPAN) for immediate references. These are available by contacting:

    · ASA Publications Department, 520 N. Northwest Highway, Park Ridge, IL 60068-2573. Phone: (847) 825-5586. Web: http://www.asahq.org. Standards are free.

    · ASPAN Member Services, 6900 Grove Road, Thorofare, NJ 08086. Phone: (609) 845-5557, ext: 377. E-mail: aspan@slackinc.com. Web: www.aspan.org. Cost. $30 for ASPAN members, $50 nonmembers. Shipping: $5.