PACU RN

Staff Nurse - Pre-Op and Post Anesthesia Care Unit

Tennessee Orthopaedic Alliance (TOA) is the largest orthopaedic surgery group in Tennessee, with more than 35 locations across the state. Our commitment to Trust, Respect, Honesty, Teamwork, Communication, Diversity, and Accountability guides how we work and how we care for our patients and communities. Who we are defines how we care: Culture: A shared commitment to Trust, Respect, Honesty, Teamwork, Communication, Diversity, and taking accountability for our own actions with the belief that every one of us makes a difference. Patient Access: Setting the standard for orthopedic care in Tennessee with access to over 35 locations across the state, including Ambulatory Surgery Centers. Patient Experience: Building strong and authentic relationships with our patients and communities by unifying through consistent collaboration to deliver exceptional patient experiences. Financial Stewardship: Using sound judgement to make responsible financial decisions; minimizing waste and maximizing value.

The staff nurse under the supervision of the PAT/Pre-op/PACU Coordinator, is responsible for the nursing care of the patient in the Pre-Op and Post Anesthesia Care Area. Participates as a team member in the planning and implementing of patient care. Directs and assists in carrying out the standards of Pre-Op and PACU. Offers leadership and direction to nursing and medical assistants. Assures continuity of care from pre-operative visit through surgical procedure and until post-operative follow-up.

Objectives:

• Identifies patient armband and greets patient and family.
• Checks and assures that physician's preoperative orders are complete
• Verifies surgical site verbally with patient.
• Assess patient's understanding of procedure and checks surgical consent for accuracy and completeness.
• Obtains signature on surgical consent when appropriate.
• Obtains history and performs physical and psychological assessment of the patient, identifying physical and emotional status.
• Obtains vital signs upon admission, recheck if abnormal.
• Initiates intravenous therapy as indicated utilizing aseptic technique with appropriate I.V. catheter and fluid.
• Administers preoperative medications as prescribed and monitors patient appropriately until transferred to the O.R.
• Documents assessment and nursing care on appropriate records.
• Reports test abnormalities and any other pertinent information to surgeon and anesthesia.
• Assesses patient's level of fear/anxiety and provides comfort and support for patient and family.
• Maintains patient's privacy, comfort, and safety in the holding area, i.e. bed rails up, brakes on stretchers, etc.

Responsibilities of a Staff Nurse - Post Anesthesia Care Unit:

Assumes primary role of patient's care delivery.

Exhibits ability to coordinate the flow of patients as directed.

Nurse patient ratio for Class I patients is 1 : 2.5.

Is responsible for Pre-Op and PACU records completed in legible handwriting.

Is responsible for implementing physician's orders.

Will utilize and document the nursing process on each patient admitted to Pre-Op and PACU.

Is knowledgeable in critical care management in the post-operative patient.

Sets up and assists in procedures performed in PACU such as nerve blocks and manipulations.

Is responsible for control drug counts.

Is responsible for code cart (making sure all code cart drugs are in date), glucose checks, MH cart and fridge temps.

Is responsible for maintaining a clean and orderly work environment.

Maintain narcotic inventory and proper records for DEA as assigned.

Maintain anesthesia drug inventory and Pre-Op and PACU drug supply inventory - keeping all drugs in date as assigned.

Responsible for the removal of bio-hazard waste and proper handling and care of bio-hazard waste.

Maintain patient nourishment stock as assigned.

Follow pharmacy services policies in accordance with all federal, state and local laws.

Performs all other duties assigned.

Pre-op admission:

• Be responsible for appraising cleanliness of the Pre-Op and Post Anesthesia Care Unit and equipment, operational efficiency of equipment, and for taking steps to solve existing problems prior to admission of patient.
• Assist in room and stretcher cleaning and re-stocking of supplies between patients to ensure a safe, clean environment.
• Be responsible for stocking Pre-op and PACU with equipment and supplies.
• Admit patient at proper time, observe patient and identify him by name, DOB, place I.D. arm band on wrist, observe and chart vital signs, check completeness and accuracy of operative consent form and lab reports, inform surgeon and Clinical Coordinator of any pertinent observations regarding symptoms or reactions, and prepare skin of operative site according to physician's orders.

PACU Admission:

• At least one nurse is expected to meet the patient at patient bay upon arrival from the O.R.
• Check patient by uncovering chest for adequate respirations.
• Note at this time color and condition of skin.
• Note type of airway and rate and depth of respirations.
• Maintain a patent airway whether by means of oral or nasal airway, endotracheal tube, or hyperextension of the jaw and neck to prevent prolapse of the tongue and occlusion of the airway.
• Suction as indicated to prevent aspiration of secretions or vomitus.
• Check pulse, blood pressure, temperature and SA02 and record.
• Report any abnormality to the anesthesiologist.
• Note the anesthetics and drugs used during surgery for their effect on vital signs.
• Inspect dressings; check for bleeding.
• Record status of dressing and type, if any.
• Check intravenous fluids for infiltration.
• Chart type of fluid which is hanging, amount infused, rate of infusion, infusion site, and condition of infusion site.
• DO NOT LEAVE a patient with an airway in place unattended for any reason.
• DO NOT LEAVE children unattended for any reason.
• Vital signs are to be checked every 15 minutes or more often at the nurse's discretion, or if the physician's orders indicate.
• Keep patient as quiet as possible and as comfortable as possible.
• Supply emotional support, allay fears, and anxieties.
• Medication as prescribed for pain should be given as needed in judgment of nurse.
• Check postoperative orders and administer any stat medications or treatments.
• Begin postoperative treatment at once, attach any drainage apparatus, change dressing as ordered, apply ice compresses, etc.
• Airways should remain in place until patient has reacted enough to maintain his own and is able to swallow.
• Keep an accurate record of vital signs, medications, I&O, and patient's condition.
• All IV's will be discontinued prior to discharge unless otherwise ordered by physician.

Discharging patient from PACU:

• The patient is evaluated and discharged by the Anesthesiologist when discharge criteria has been met.
• Patients discharged from PACU should be accompanied home when they are determined stable.
• Patients will not be allowed to go home without assistance; unless the patient receives local anesthesia only.
• Discharge patient by wheelchair when medically advisable to care of responsible adult.
• Written instructions as well as verbal should be given to each patient and the accompanying responsible adult.
• Complete patient record and attach EKG tracing

Preparing for next day surgeries:

• Check charts for the next day's surgery.
• Make sure you have all drugs in stock that are ordered for the next day.
• Make certain that all reports are on the chart.
• All abnormal reports must be cleared by anesthesia.
• Anything missing must be noted on the front of the chart.
• Prepare Pre-Op and PACU for the next day.
• Assemble gowns, pre-op kits and I.V. fluids for the number of patients scheduled.

Additional duties:

• Telephone patients who had surgery the previous day.
• Start telephone calls by 9:00 A.M. and continue for three consecutive days.
• Record post-op status on Post-operative Call Sheet in medical record.
• Count narcotics inventory daily and sign