Perioperative Nurses Chapter�42^nd Annual Scientific Conference�

Presenter: Winnyrose Chirchir

Metrine Nayere

Institution :Moi Teaching and Referral Hospital

Evidenced-based practice�Optimized PACU care

Introduction

• The Post-Anaesthesia Care Unit (PACU) is a critical area where patients recover immediately after surgery.
• Optimal PACU management is essential for:
• Reducing postoperative complications
• Ensuring safe recovery from anaesthesia
• Enhancing patient outcomes and satisfaction

Aim

• To discuss strategies for optimising PACU care through evidence-based practices, teamwork, and technology.

Objective

• Review current standards of PACU management.
• Identify challenges affecting optimal care delivery.
• Discuss interventions and innovations that improve patient outcomes.
• Highlight the role of multidisciplinary collaboration.

Components of Optimised PACU Care

• A. Pain and comfort management
• Pain assessment using validated scales.
• 1. Numeric Rating Scale (NRS)
• - 0-10 scale: Patients rate their pain from 0 (no pain) to 10 (worst possible pain)
• 0 - No Pain
• 1-3 - Mild Pain
• 4-6 - Moderate Pain
• 7-8 - Severe Pain
• 9-10 - Worst Possible Pain

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• 2. Visual Analog Scale (VAS)
• Continuous scale: Patients mark a point on a line that corresponds to their pain level, often anchored by "no pain" and "worst possible pain"
• 3. Faces Pain Scale (FPS)
• Series of faces: Patients select a face that corresponds to their pain level, often used for pediatric patients
• Management; Multimodal analgesia (opioids, NSAIDs, local anaesthetics, non-pharmacologic measures)

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B. Airway and Respiratory Management

• Ensuring airway patency, oxygen therapy as needed.
• Early identification of airway obstruction or aspiration risk.
• Encouraging deep breathing and coughing exercises

C. Patient Monitoring

• Continuous assessment of vital signs (ECG, oxygen saturation, blood pressure, temperature).
• Early detection of respiratory or cardiovascular compromise.
• Use of early warning scores for timely interventions.

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D. Fluid and Haemodynamic Stability

• Continuous monitoring of fluid balance.
• Rapid response to hypotension or bleeding.
• Maintaining normovolemia to support recovery.

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E. Efficient discharge criteria and Protocols

• Aldrete scoring system

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• Scoring:
• - 8-10 points: Ready for discharge from PACU
• - 0-7 points: Patient may require further care and monitoring
• This table summarizes the Aldrete scoring system, which assesses patients' recovery from anesthesia.

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F. Multidisciplinary Communication

• Handover using structured tools like SBAR (Situation–Background–Assessment–Recommendation).
• S - Situation: [Patient's Name] is experiencing [briefly describe the current situation or concern].
• B - Background: [Patient's Name] has a history of [relevant medical history] and is currently on [current treatments].
• A - Assessment: [Patient's Name]'s current vital signs are [list vital signs]. Lab results show [notable lab results].
• R - Recommendation: I recommend [specific actions, treatments, or interventions needed]. Can we discuss further and agree on a plan?"
• Clear communication between anaesthetists, nurses, and surgeons.

Challenges in PACU care

• Limited staffing.
• Variation in monitoring practices.
• Inadequate pain control protocols.
• Delays in patient transfer or discharge.
• Insufficient staff training.

Strategies for Optimisation

• Regular staff training and simulation drills.
• Implementation of Enhanced Recovery After Surgery (ERAS) protocols.
• Use of checklists and standardised discharge criteria.
• Integration of digital health records for efficiency.
• Continuous quality assurance audits.

Conclusion

• Optimising PACU care is vital for ensuring safe and efficient postoperative recovery.
• Through evidence-based protocols, skilled teamwork, technology, and continuous evaluation, healthcare facilities can improve outcomes and elevate the quality of perioperative care.

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