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Recently our Clinical Practice Committee received an “SOS” from
a member in the northeast concerned about the trend in her
facility to use PACU as a “catch all” for special procedures
other than those defined in our scope of practice. This
suggestion to utilize the PACU has been couched in the praise of
the strong critical care competencies of the nursing staff,
which are undeniable, and with the intent that these procedures
can be scheduled during “slow times.” The nurse went on to say
that she felt conflicted because the staff are there for the
patients no matter what is in the offing, but this loosely
defined consideration for utilization has the potential to
interfere with the primary purpose of Phase I, which is to
provide basic life saving measures and constant vigilance for
those patients recovering from anesthesia.1 These
issues go beyond our “overflow” concerns.
The
above “SOS” came within days of a query I received from a
colleague within my personal practice network regarding the
possibility of melding Phase I and II in an effort to best
utilize staff and optimize space. I had also recently attended
an Ambulatory Surgery Center design workshop where the
efficiency of design centered on using single patient
rooms for both Phase I and Phase II postanesthesia
recovery. For the latter, I believe providing the staffing ratio
would be prohibitive. My response to each situation was directly
supported by the ASPAN Standards and, hopefully, hit home with
those framing these concepts!
Needless to say, this series of events has heightened our
awareness that, more than ever, perianesthesia nurses need our
Standards, Resources, and Position Statements to give strength
to their voices in the workplace. We are challenged to continue
to expand our research initiatives to support our Standards with
evidence-based practices. We are challenged to expand our circle
of influence beyond the practice of perianesthesia nursing and
into the administrative and legislative arenas to assure best
practices are supported with patient safety the highest
priority.
What can you do? Begin with the identification of the specific
problems that effect your daily provision of safe care for
recovering patients. In response to the definition of “slow
times,” cite that the OR schedule alone provides minimal
information about predicting the flow of patients. Every
anesthetic and surgical experience is different; there are no
absolutes. Additionally, the nurse providing assistance with a
cardioversion cannot be relied upon to be available for
postanesthesia care delivery. Consider the availability of PACU
resources such as RNs, space, and equipment. Each of these
resources is predetermined based on postanesthesia needs and
should not be “stretched” to provide backup for other
disciplines. Discuss the unpredictability of patient admissions
from areas outside the OR providing Sedation/Analgesia or
Monitored Anesthesia Care. Collect your data and let your
Standards be your guide.
Who
makes decisions for your unit? Make the argument that a
perianesthesia prepared nurse be part of the collaboration with
the anesthesia caregivers and nursing administration to solve
flow problems in PACU. Only a perianesthesia nurse can identify
the nuances of our practice and can foresee the potential
problems, as well as possible solutions. We know flexibility. We
worry about the “what ifs” and we are ready to preempt
emergencies. We understand core systems.
Phase I nurses must be ever ready to deal with immediate
postanesthesia care delivery, thus preventing complications and
moving the patient safely to the next level of care. Our
exceptional management of daily activity and autonomous nature
may be the biggest “problem.” We look like the ideal place to
give phenomenal care to everyone’s patients. We are so well
prepared, handle chaos, and make it all look so easy. We are
exceptional caregivers. Yet, I urge you to take advantage to the
strength ASPAN can offer you and rely on our Standards and
network to support your efforts for perianesthesia care
delivery. ASPAN, with your input, continues to define the
perianesthesia practice of tomorrow.
Reference
1. American Society of PeriAnesthesia Nurses: Standards of
Perianesthesia Nursing Practice. Cherry Hill, NJ, ASPAN, 2002. |
