IntroductionRoutine post anaesthetic observations are an requirement for patient assessment and the recognition of clinical deterioration in post-operative patients; acknowledging that children are at a high
risk of complications post anesthetics, surgeries and procedures. Show
AimThis guideline applies to all patients after a general anaesthetic for whom the ‘
Post-Operative Discharge Criteria Following General Anaesthesia for Minor Surgical Procedures’ does not apply. This guideline provides guidance for:
Note that this is a guideline only and does not replace the need for clinical judgment on an individual basis. Definition of terms
AssessmentInitial assessment - PACUWhen admitting
a patient to PACU patient identification and handover should occur utilising the Handover Flowsheet. Post-operative orders must be communicated both verbally and documented in the EMR. Post-operative orders are additional to the operation report. Clinical handover should highlight any issues throughout the intra-operative period, acknowledge the process for escalation of care, should this be required and allow for clarification of any instructions before accepting care of the patient.
Observations continue at least 15 minutely, or more frequently as clinically indicated
Continuous Oximetry monitoring should be initiated for all patients admitted to PACU Patients are ready to transfer to the ward once they meet the PACU ‘Discharge Criteria’ (see below) and ‘Ready for Discharge’ both of which are timestamped on EMR. PACU ‘Discharge Criteria’
If there is a delay in transfer of patient related to inability of inpatient unit to accept care, then observations in the PACU will continue to be 15 minutely as per ACORN standards. Management once transferred to an Inpatient Unit
The time frame for routine post anaesthetic observations should commence once the PACU nurse has deemed the patient ‘Ready for Discharge’. See special considerations for how to locate this on EMR. Frequency of routine post anaesthetic observations:
Routine post anaesthetic observations should include:
Consider the need for continuous pulse oximetry and/or cardio-respiratory monitoring as indicated by patient’s condition.
For further information regarding modification on the MET criteria please see the Medical Emergency Response Procedure. Ongoing observationAt the completion of the RPAO’s, the type and frequency of clinical observations must reflect the clinical status, therapies and interventions being delivered to the child and be consistent with requirements of other individual guidelines and procedures.
Note, other children may require hourly observations and continuous monitoring as clinically indicated. Observation frequency can be ordered in the EMR.
Escalation of careIf you are concerned about the child for whom you are caring, please refer to the Medical Emergency Response Procedure. If immediate review is required in a deteriorating child, call a MET (dial 22 22 and state building, level, ward and room number). Special Considerations
Companion documents
Evidence tableRoutine Post Anaesthetic Observation Guideline Evidence Table Please remember to read the disclaimer The development of this nursing guideline was coordinated by Stacey Richards, Nursing Research, CNC, and approved by the Nursing Clinical Effectiveness Committee. Updated November 2019. What criteria are used to determine when a patient is ready for discharge from the PACU?Discharge/Transfer Criteria from PACU
Protective reflexes are intact; airway is patent; respiratory function and oxygen saturation are stable. 2. Vital signs are stable, including temperature.
What 4 criteria are assessed during a post op assessment?This assessment should include the intraoperative history and post-operative instructions, circulatory volume status, respiratory status and cognitive state.
What parameters are assessed in Postanesthesia care?Perioperative and postanesthetic management of the patient includes periodic assessment and monitoring of respiratory and cardiovascular function, neuromuscular function, mental status, temperature, pain, nausea and vomiting, drainage and bleeding, and urine output (table 1).
What determinants are used to measure patient readiness to be discharged from the post anesthesia care unit PACU and transferred to the surgical floor?Post-Anesthetic Recovery Scoring System (PAS) will be used by the PACU RN to assess patient readiness for discharge from Phase I. In addition, an anesthesia order for transfer to a nursing unit or discharge will be reflected on the PACU order.
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