4. STANDARDS FOR POSTANESTHESIA CARE.
These standards apply to postanesthesia care in all locations. These standards do not apply to Obstetric Epidural Analgesia or Pain Management. These standards may be exceeded based on the judgment of the responsible anesthesiologist. They are intended to encourage high quality patient care, but cannot guarantee any specific patient outcome. Extenuating circumstances may require deviation from the standard, but a note in the patient's record concerning any deviation, shall be made in a timely fashion. These standards are subject to revision from time to time, as warranted by the evolution of technology and practice.
A. STANDARDS: All patients who have received general anesthesia, regional anesthesia, or monitored anesthesia care shall receive appropriate postanesthesia management.
(1) A Postanesthesia Care Unit (PACU) or an area which provides equivalent postanesthesia care shall be available to receive patients after surgery and anesthesia. All patients who receive anesthesia shall be admitted to the PACU, except by specific order of the anesthesiologists responsible for the patient's care.
(2) The medical aspects of care in the PACU shall be governed by policies and procedures which have been reviewed and approved by the Department of Anesthesiology.
(3) The design, equipment and staffing of the PACU shall meet requirements of the facility's accrediting and licensing bodies.
(4) The nursing standards of practice shall be consistent with those approved in 1986 by the American Society of Post Anesthesia Nurses (ASPAN).
B. STANDARD: patient transported to the PACU shall be accompanied by a member of the Anesthesia Care Team who is knowledgeable about the patient's condition. The patient shall be continually evaluated (i.e., repeated regularly and frequently) and treated during transport with monitoring and support appropriate to the patient's condition.
C. STANDARD: Upon arrival in the PACU, the patient shall be reevaluated and a verbal report provided to the responsible PACU nurse by the member of the Anesthesia Care Team who accompanies the patient.
(1) The patient's status on arrival in the PACU shall be documented.
(2) Information concerning the preoperative condition and the surgical/anesthetic course shall be transmitted to the PACU nurse.
(3) The member of the Anesthesia Care Team shall remain in the PACU until the PACU nurse accepts responsibility for the nursing care of the patient.
D. STANDARD: The patient's condition shall be evaluated continually in the PACU.
(1) The patient shall be observed and monitored by methods appropriate to the patient's medical condition. Particular attention should be given to monitoring oxygenation, ventilation and circulation. During recovery a quantitative method of assessing oxygenation, such as pulse oximetry, shall be employed.
(2) An accurate written report of the PACU period shall be maintained.
(3) General medical supervision and coordination of patient care in the PACU should be the responsibility of an anesthesiologist.
(4) There shall be a physician in the facility capable of managing complications and providing cardiopulmonary resuscitation for patients in the PACU.
E. STANDARD: physician is responsible for the discharge of the patient from the Postanesthesia Care Unit.
(1) When discharge criteria are used, they must be approved by the Department of Anesthesiology. They may vary, depending upon whether the patient is discharged to a hospital room, to the ICU, to a short stay unit, or home.
(2) In the absence of the physician responsible for the discharge, the PACU nurse shall determine that the patient meets the discharge criteria. The name of the physician accepting responsibility for discharge shall be noted in the record.
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