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Post Anesthesia Care Unit PACU - Nurses in the PACU 1. $10.00 refundable deposit for Instructor Manual and each New Instructor New Employee Orientation If you are searching for the ebook Orientation manuals for new pacu nurses in pdf format, in that case you come. Written and peer-reviewed by perianesthesia experts, this manual outlines essential performance criteria to be utilized in the orientation process of the nurse new to perianesthesia care, a reference of best practices for the veteran nurse, and a source of annual clinical updates for the entire perianesthesia. Follow these guidelines when developing a PACU policy and procedure. QUESTION: We are working on a policy and procedure for our post anesthesia care unit (PACU) and would like to know when it is appropriate to charge recovery services post procedure.

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APCs Insider, September 9, 2005

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Follow these guidelines when developing a PACU policy and procedure

QUESTION: We are working on a policy and procedure for our post anesthesia care unit (PACU) and would like to know when it is appropriate to charge recovery services post procedure.

For example, is it appropriate to charge PACU for gastrointestinal (GI) lab procedures that a physician performs during surgery, and the patient recovers in our PACU? For a GI lab procedure performed and recovered in our GI lab? How about for bronchoscopy procedures that a physician performs in surgery and after which the patient recovers in PACU?

Also, what documentation is necessary to support PACU charges? For example, is an MD order appropriate, even though surgery does not use one? Should our policy and procedure factor in facility and JCAHO guidelines, staffing issues, and location of care?

ANSWER: The justification for PACU begins with medical necessity. To our knowledge, there are no LMRPs for PACU. Therefore, consider the medical needs for a patient in PACU. Typically, staff will monitor the patient's airway (oxygen sat, respiratory, etc.), circulation (blood pressure, heart rate), bleeding (or other complication resulting from procedure including pain), temperature, urine output, medication toleration, and conscious level.

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If the patient doesn't develop complications or problems in these areas in the first hour they are unlikely to develop any at all, and you can discharge the patient. The key to PACU is that this area of the hospital has the equipment and staffing levels to provide very close monitoring of these facets of a patient's condition.

It is difficult to categorically state that all patients undergoing a specific procedure will require PACU, particularly with simpler/less complex procedures. One may argue that the less invasive/lower anesthesia/shorter duration procedure won't need PACU at all. The problem is that each person is unique, and we must allow for special cases or unusual reactions. The best that we can do is state that under normal circumstances, a patient undergoing a particular procedure doesn't require time in the PACU (even though this can depend on the discharge criteria from the operating room).

One rule of thumb to consider is that if the physician can perform the procedure in a treatment room, rather than the OR, it is likely that the patient will not need to recover in the PACU. In larger hospitals with treatment rooms that rival OR rooms, this general rule may not apply.

However you must consider why a physician performs a procedure in the OR. Did he or she perform it in the OR because the patient needed that level of care? Did the physician need access to equipment/staff at that level? Or did he or she perform it because it is the most convenient location? Given all these disclaimers, we would say generally speaking from a medical necessity perspective GI/bronchoscopy procedures do not require PACU time.

Regarding documentation, often times physicians do not document procedures. Occasionally, for major procedures, you will see one on the order sheet. Your facility will likely meet the basic requirement for PACU if it has standing orders which direct certain patients based upon either the procedure they had or symptoms they had to the PACU. The same holds true for discharge criteria. In order for staff to discharge a patient from the PACU, they should meet clear objectives, otherwise you will find that the payer will debate the length of time in PACU.

Location is important. To be classified a PACU or recovery room, the area must provide a certain level of care (i.e. to be able to monitor the criteria discussed in paragraph one). The location can be the same place where the physician performed the procedure, provided the level of care is commensurate with the PACU. Once the care level drops to that which is typically seen in an outpatient or medical floor, then it is no longer considered PACU.

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Hello and welcome to the Holding Room/PACU, located on the 3rd floor of Vanderbilt University Adult Hospital (VUAH).

The environment on our unit is friendly and family-oriented. Leadership is supportive of personal and professional staff growth. We have many highly experienced nurses with ICU backgrounds. Staff is very supportive of each other. They readily welcome and share their knowledge with all new nurses. They are always eager to help and “pitch in” when needed.

We care for adult patients who electively or emergently are having surgery.
Our patients may be having a simple procedure that allows them to go home the same day or maybe undergoing very complex surgeries that will require them to be cared for in an intensive care setting. Surgery is a unique place in healthcare. After surgery, patients’ lives are changed.

There are many advantages to working in VOR Holding/PACU. New Graduate Nurses receive support from experienced Clinical Staff Leaders and staff. We have a flexible scheduling system with a variety of 9, 10, and 12-hour shifts. Staff can have the opportunity to connect with multiple patients and families every day and at the most vulnerable and critical time in their lives.

Our nurses are successful because we maintain a strong Shared Governance structure. Our Unit Board meets every month. Staff work with leadership addressing all aspects of their practice to improve the care of patients/families and increase satisfaction in their work environment.

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Pacu Orientation Manual