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Journal articles on the topic 'PACU nursing'

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Author: Grafiati

Published: 10 December 2022

Last updated: 28 January 2023

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1

Street, Maryann, Nicole M. Phillips, Mohammadreza Mohebbi, and Bridie Kent. "Effect of a newly designed observation, response and discharge chart in the Post Anaesthesia Care Unit on patient outcomes: a quasi-expermental study in Australia." BMJ Open 7, no. 12 (December 2017): e015149. http://dx.doi.org/10.1136/bmjopen-2016-015149.

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ObjectivesThis study aimed to evaluate whether use of a discharge criteria tool for nursing assessment of patients in Post Anaesthesia Care Unit (PACU) would enhance nurses’ recognition and response to patients at-risk of deterioration and improve patient outcomes.MethodsA prospective non-randomised pre–post intervention study was conducted in three hospitals in Australia. Participants were adults undergoing elective surgery before (n=723) and after (n=694) implementation of the Post-Anaesthetic Care Tool (PACT).ResultsNursing response to patients at-risk of deterioration was higher using PACT, with more medical consultations initiated by PACU nurses (19% vs 30%, P<0.001) and more patients with Medical Emergency Team activation criteria modified by an anaesthetist while in PACU (6.5% vs 13.8%, P<0.001). There were higher rates of analgesia administration (37.3% vs 54.2%, P=0.001), nursing assessment of pain and documentation of ongoing analgesia prior to discharge (55% vs 85%, P<0.001). More adverse events were recorded in PACU after introduction of the PACT (8.3% vs 16.7%, P<0.001). The rate of adverse events after discharge from PACU remained constant (16.5%), but the rate of cardiac events (5.1% vs 2.6%, P=0.021) and clinical deterioration (8.7% vs 4.3%, P=0.001) following PACU discharge significantly decreased, using the PACT. Despite the increased number of patients with adverse events in phase 2, healthcare costs did not increase significantly. Length of stay in PACU and length of hospital admission for those patients who had an adverse event in PACU were significantly reduced after implementation of the PACT.ConclusionThis study found that using a structured discharge criteria tool, the PACT, enhanced nurses’ recognition and response to patients who experienced clinical deterioration, reduced length of stay for patients who experienced an adverse event in PACU and was cost-effective.

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Hughes, Jaclyn, Toni Velasquez, and Maria Saraceni. "PACU Education Standardization for PACU Protocols." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e8. http://dx.doi.org/10.1016/j.jopan.2022.05.021.

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Williams, Brian A., Michael L. Kentor, John P. Williams, Molly T. Vogt, Stacey V. DaPos, Christopher D. Harner, and Freddie H. Fu. "PACU Bypass after Outpatient Knee Surgery Is Associated with Fewer Unplanned Hospital Admissions but More Phase II Nursing Interventions." Anesthesiology 97, no. 4 (October 1, 2002): 981–88. http://dx.doi.org/10.1097/00000542-200210000-00034.

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Background The authors recently proposed a recovery scoring system for outpatients receiving regional anesthesia (RA) or general anesthesia (GA). This scoring system was designed to allow qualifying patients to be directly routed to the phase II (step-down) recovery unit instead of the traditional postanesthesia care unit (PACU). We report PACU bypass rates using these criteria, and the extent to which PACU bypass was associated with (1) required nursing interventions in the step-down recovery unit, and (2) successful same-day discharge. Methods Day-of-surgery outcomes were studied for 894 outpatients undergoing outpatient sports medicine surgery on the lower extremity. We determined PACU-bypass rates, nursing interventions in the step-down recovery unit for common symptoms, and unplanned hospital admissions. Using logistic regression, we analyzed step-down nursing interventions based on PACU requirement versus PACU bypass, and anesthesia techniques used (GA vs. not, peripheral nerve blocks vs. not). Results Eighty-seven percent (778/894) of all patients bypassed PACU. Of PACU-bypass patients, 241/778 (31%) required step-down nursing interventions. Of patients requiring PACU, only 19/116 (16%) required additional interventions in step-down (P < 0.001). PACU-bypass patients were almost three times more likely (odds ratio 2.9,P < 0.001) to require at least one nursing intervention in the step-down unit, when compared with patients requiring PACU. Fewer unplanned admissions were required by patients who bypassed PACU (odds ratio = 0.3,P = 0.007). Conclusions For outpatient lower extremity surgery, applying our PACU-bypass criteria led to an 87% PACU bypass rate with no reportable adverse events.

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Weiser, Marcia Lynn. "Consider a career in PACU nursing." OR Nurse 4, no. 5 (September 2010): 16–17. http://dx.doi.org/10.1097/01.orn.0000387276.95272.c5.

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Bancroft, Denise, and Jeanne Tennis. "Optimizing Nursing Continuing Education in PACU." Journal of PeriAnesthesia Nursing 27, no. 3 (June 2012): e29. http://dx.doi.org/10.1016/j.jopan.2012.04.113.

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Templonuevo, Mark, Elsy Puthenparampil, Soo Ok, Jingle Alcazaren, Marissa Aquino Gado, Lady June Avergonzado Boholst, Dwayne E. Brown, et al. "Debunking the Myths of PACU Nursing Documentation." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e7-e8. http://dx.doi.org/10.1016/j.jopan.2022.05.019.

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Duncan, Katherine, Caron Hong, Beatrice Hazzard, Laura Haines, Lynnae Elliotte, and Michaela Mathews. "PACU Nursing Protocol for Suspected Corneal Abrasions." Journal of PeriAnesthesia Nursing 31, no. 4 (August 2016): e23-e24. http://dx.doi.org/10.1016/j.jopan.2016.04.055.

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Cohen, Marsha M., Linda L. O'Brien-Pallas, Christine Copplestone, Ronald Wall, Joan Porter, and Keith D. Rose. "Nursing Workload Associated with Adverse Events in the Postanesthesia Care Unit." Anesthesiology 91, no. 6 (December 1, 1999): 1882. http://dx.doi.org/10.1097/00000542-199912000-00043.

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Background The authors used a nursing task inventory system to assess nursing resources for patients with and without adverse postoperative events in the postanesthesia care unit (PACU). Methods Over 3 months, 2,031 patients were observed, and each task/activity related to direct patient care was recorded and assigned points according to the Project Research in Nursing (PRN) workload system. PRN values for each patient were merged with data from an anesthesia database containing demographics, anesthesia technique, and postoperative adverse events. Mean and median PRN points were determined by age, sex, duration of procedure, and mode of anesthesia for patients with and without adverse events in the PACU. Three theoretical models were developed to determine the effect of differing rates of adverse events on the requirements for nurses in the PACU. Results The median workload (PRN points) per patient was 31.0 (25th-75th percentile, 25-46). Median workload was 26 points for patients with no postoperative events and 155 for > or = six adverse events. Workload varied by type of postoperative event (e.g., unanticipated admission to the intensive care unit, median workload = 95; critical respiratory event = 54; and nausea/vomiting = 33). Monitored anesthesia care or general anesthesia with spontaneous ventilation used less resources compared with general anesthesia with mechanical ventilation. Modeling various scenarios (controlling for types of patients) showed that adverse events increased the number of nursing personnel required in the PACU. Conclusions Nursing care documentation based on requirements for individual patients demonstrates that the rate of postoperative adverse events affects the amount of nursing resources needed in the PACU.

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Ramsey, Savannah, Summer Fitts, and LeighAnn Chadwell. "Peace in the PACU." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e16. http://dx.doi.org/10.1016/j.jopan.2022.05.042.

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Kang, Minyeong, Eun Young Kim, and Sung Ok Chang. "Nurses' management of older patients with post-anesthesia delirium: A Q methodology approach." Journal of Korean Gerontological Nursing 24, no. 4 (November 30, 2022): 454–63. http://dx.doi.org/10.17079/jkgn.2022.24.4.454.

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Purpose: This is an analysis of the experiences of nurses in Post Anesthesia Care Units (PACUs) in caring for older patients with emergence delirium using the Q-methodology. Methods: The Q-methodology, which is used to explore and understand human subjectivity, was applied. Thirty nurses who had experiences in providing nursing for delirium in older patients after surgery in a PACU participated in this study. Results: This study revealed three factors regarding the frame of reference of PACU nurses in detecting and managing older patients' emergence delirium: “detect the deviant changes leading to instability”, “focus on the patient’s degree of cognitive recovery within the framework of recovery time”, and “awareness of possible clues based on the patient’s underlying disease(s)”. Conclusion: These findings are expected to be utilized as a basis for more practical and accessible PACU nurse delirium education that reflects nurses’ subjective viewpoints explained by the three identified factors.

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Weiser, Marcia Lynn. "Wake up to a career in PACU nursing." Nursing 39 (January 2009): 8. http://dx.doi.org/10.1097/01.nurse.0000343086.75289.96.

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Cushing, Maureen. "Back to (PACU) Basics." AJN, American Journal of Nursing 92, no. 7 (July 1992): 21–22. http://dx.doi.org/10.1097/00000446-199207000-00013.

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13

Xuan, Hongmei, and Keping Xu. "Warning and Nursing Experience of Anesthesia Depth Monitoring for Patients with General Anesthesia Delayed to Leave Anesthesia Recovery Room and Delirium." Emergency Medicine International 2022 (November 10, 2022): 1–5. http://dx.doi.org/10.1155/2022/3610838.

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Affected by the residues of narcotic drugs, patients under general anesthesia are vulnerable to emergence of agitation, delirium, hemodynamic changes, and other adverse events in the recovery period of anesthesia. Therefore, it is necessary to strengthen the observation and care of these patients. Depth of anesthesia monitoring (DAM) has always been a concern for anesthesiologists, but there are few reports related to it. This study compared the early warning value of DAM for patients under general anesthesia with delayed exit from the anesthesia recovery unit (PACU) and delirium and summarized the related nursing experience. The results showed that DAM could reduce the incidence of complications in patients under general anesthesia, reduce the incidence of delirium, shorten the time of postoperative anesthesia recovery and PACU observation time, reduce the workload of nursing staff, and improve nursing satisfaction. DAM plays an important role in improving the quality and efficiency of care in PACU.

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Sutedja, Erlien, Claire R. Zimmermann, Cecilia Rima Rodriguez, Yolanda de Leon Ayson, and Judith Payne. "Nursing Management of Arterial Catheters in Pacu and PTU." Journal of PeriAnesthesia Nursing 26, no. 3 (June 2011): 197. http://dx.doi.org/10.1016/j.jopan.2011.04.058.

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Stocki, Daniel, Conor McDonnell, Gail Wong, Gloria Kotzer, Kelly Shackell, and Fiona Campbell. "Knowledge translation and process improvement interventions increased pain assessment documentation in a large quaternary paediatric post-anaesthesia care unit." BMJ Open Quality 7, no. 3 (August 2018): e000319. http://dx.doi.org/10.1136/bmjoq-2018-000319.

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BackgroundDue to inadequate pain assessment documentation in our paediatric post-anaesthetic care unit (PACU), we were unable to monitor pain intensity, and target factors contributing to moderate and severe postoperative pain in children. The purpose of this study was to improve pain assessment documentation in PACU through a process improvement intervention and knowledge translation (KT) strategy. The study was set in a PACU within a large university affiliated paediatric hospital. Participants included PACU and Acute Pain Service nursing staff, administrative staff and anaesthesiologists.MethodsThe Plan–Do–Study-Act method of quality improvement was used. Benchmark data were obtained by chart review of 99 patient medical records prior to interventions. Data included pain assessment documentation (pain intensity score, use of validated pain intensity measure) during PACU stay. Repeat chart audit took place at 4, 5 and 6 months after the intervention.InterventionKey informant interviews were conducted to identify barriers to pain assessment documentation. A process improvement was implemented whereby the PACU flowsheets were modified to facilitate pain assessment documentation. KT strategy was implemented to increase awareness of pain assessment documentation and to provide the knowledge, skill and judgement to support this practice. The KT strategy was directed at PACU nursing staff and comprised education outreach (educational meetings for PACU nurses, discussions at daily huddles), reminders (screensavers, bedside posters, email reminders) and feedback of audit results.ResultsThe proportion of charts that included at least one documented pain assessment was 69%. After intervention, pain assessment documentation increased to >90% at 4 and 5 months, respectively, and to 100% after 6 months.ConclusionAfter implementing process improvement and KT interventions, pain assessment documentation improved. Additional work is needed in several key areas, specifically monitoring moderate to severe pain, in order to target factors contributing to significant postoperative pain in children.

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Lucido, Gloriana, Wanda Rodriquez, Jacquelyn Borja, Nedrick Campbell, Priyanka Desai, Lesly Moran, Elizabeth Oliver, and Jennifer Simon. "Discharge Scoring Tool in Ambulatory PACU." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e19. http://dx.doi.org/10.1016/j.jopan.2022.05.050.

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Bateman, Inge D. "Discussion of the relevance and practicality of taking a Post-Anaesthetic Care Unit nurse into the era of nurse consultants posts." British Journal of Anaesthetic and Recovery Nursing 1, no. 2 (May 2000): 19–23. http://dx.doi.org/10.1017/s1742645600000267.

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The reason for choosing this subject is because it is highly relevant since Trusts are currently in the process of establishing posts in accordance with the National Health Service (NHS) ‘Executive's Health Service Circular 217’ (1999). The political background for setting up these posts stems from the document ‘Making a Difference: Strengthening the nursing, midwifery and health visitor contribution to health and healthcare’ (Department of Health 1999a). It is also relevant in connection with nurses in general, as they are not being recognised nor rewarded for their abilities. This is especially so in PACUs where the nurse's image is low and PACU nursing is not a recognised speciality, such as Intensive Care Unit (ICU) nursing, Coronary Care Unit (CCU) nursing, High Dependency Unit (HDU) nursing and so forth. From personal experience, it has been observed that well qualified and highly experienced staff leave the clinical environment for positions in management, sales or even leave nursing altogether when no further career advancement is possible in the clinical field.

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18

Tan, Paul Michael, Jazzle Anne Magdaug, Marie Camille Agustin, and Carlo Miguel Villafaña. "Exploring CV-PACU Clinical Guidelines Utilizing Independent Perianesthesia Nursing Interventions." Journal of PeriAnesthesia Nursing 33, no. 4 (August 2018): e32. http://dx.doi.org/10.1016/j.jopan.2018.06.074.

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19

Jeske, Shelley, Tracy Boivin Oldale, and Nancy Andrews. "A Workforce Initiative: The Calgary Health Region PACU Nursing Program." Journal of PeriAnesthesia Nursing 23, no. 3 (June 2008): E14. http://dx.doi.org/10.1016/j.jopan.2008.04.054.

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Cohen, Sheila E., Catherine L. Hamilton, Edward T. Riley, Dean S. Walker, Alex Macario, and Jerry W. Halpern. "Obstetric Postanesthesia Care Unit Stays." Anesthesiology 89, no. 6 (December 1, 1998): 1559–65. http://dx.doi.org/10.1097/00000542-199812000-00036.

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Background Obstetric patients may have long postanesthesia care unit (OB-PACU) stays after surgery because of residual regional block or other conditions. This study evaluated whether modified discharge criteria might allow for earlier discharge without compromising patient safety. Methods Data were prospectively collected for 6 months for all patients (N=358) who underwent cesarean section or tubal ligation and recovered in the OB-PACU. Regional anesthesia was used in 94% of patients. The duration of anesthesia and PACU stays, the presence and treatment of events in the PACU, and the regression of neural blockade were recorded. Discharge from the OB-PACU required a 60-min minimum stay, stable vital signs, adequate analgesia, and ability to flex the knees. After completion of prospective data collection, events that kept patients in the PACU after 60 min were reevaluated as to whether patients needed to stay in the PACU for medical reasons. "Needed to stay" events included bleeding, cardiorespiratory problems, sedation, dizziness, and pain. "Safe to leave" conditions included pruritus, nausea, and residual neural blockade. The cumulative duration of OB-PACU stays not clearly justifiable for medical reasons was calculated. Results Residual block and spinal opioid side effects accounted for the majority of "unnecessary" stays. Annually, 429 h of PACU time could have been saved using the revised criteria. Complications did not develop subsequently in any patient deemed "safe to leave." Conclusions In many obstetric patients, the duration of PACU stays could safely be shortened by continuing observation in a lower-acuity setting. This may result in greater flexibility and more efficient use of nursing personnel.

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Nieh, Hsiao-Chi, and Shu-Fen Su. "Forced-Air Warming for Rewarming and Comfort Following Laparoscopy: A Randomized Controlled Trail." Clinical Nursing Research 27, no. 5 (June 14, 2017): 540–59. http://dx.doi.org/10.1177/1054773817708082.

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We investigated the efficacy of a forced-air warming (FAW) system on postoperative rewarming and comfort in patients undergoing laparoscopic surgery. In this randomized controlled trial, a total of 127 participants were randomly divided into the FAW group ( n = 64) and control group ( n = 63). The esophageal temperature was measured every 30 min during surgery, and the tympanic temperature and comfort levels were measured preoperatively and in the postanesthesia care unit (PACU). Data analysis used the generalized estimating equation. We found that there was a lower incidence of postoperative hypothermia in the FAW group compared with the control group, as well as a higher body temperature between 30 and 180 min in the PACU, a shorter time for rewarming, and a higher comfort level. Taken together, these results suggest that FAW is an effective rewarming technique for laparoscopic patients during surgery and in the PACU that improves comfort levels.

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Huang, Tzu H. "Thoracotomy Paraplegia: A Case Report from the PACU." British Journal of Anaesthetic and Recovery Nursing 12, no. 1-2 (May 2011): 14–17. http://dx.doi.org/10.1017/s1742645611000027.

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AbstractThe aim of this case report is to present the rare yet devastating complication of post-thoracotomy paraplegia and to raise awareness of the causative factors, as well as to discuss the nursing observation for prompt and effective clinical management in order to achieve successful healthcare outcomes. This case was secondary to the use of haemostatic agents during thoracotomy, and delayed post-operative identification of complication and management leading to long-term spinal cord impairment. Routine neurologic assessment focusing on movement and sensation of the extremities is recommended post-operatively to detect the potential complications as early as possible.

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Cushing, Maureen. "The Legal Side: Back to (PACU) Basics." American Journal of Nursing 92, no. 7 (July 1992): 21. http://dx.doi.org/10.2307/3426965.

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Hoke, Nicole, Michael Ham, Katherine Douglas, Nicole Miller, Danielle Mouradjian, and Tiffany M. Snow. "Preop to PACU: A Nursing Orientation Program for Preop Nurses to Attain Competency in the Care of the PACU Patient." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e9. http://dx.doi.org/10.1016/j.jopan.2022.05.023.

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Henao-Castaño, Angela María, Laura Elizabeth Pachón Cetina, and Juan David Monroy Rodríguez. "Nursing Delirium Screening Scale, a Tool for Early Detection of Delirium: Integrative Review." Aquichan 20, no. 4 (December 4, 2020): 1–14. http://dx.doi.org/10.5294/aqui.2020.20.4.5.

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Objective: To analyze the context and use of the Nursing Delirium Screening Scale (Nu-DESC) for early detection of delirium in adult patients, compiling the available evidence. Method: Searching for relevant articles on databases such as Cinahl, Medline, Ovid, Scopus, and Web of Science. Inclusion criteria: Articles written in English, Spanish, and Portuguese, published between January 2013 and October 2019. Search terms: “nursing delirium screen,” “inpatient delirium screening,” and “nursing assessment.” We identified 23 articles in which the Nu-DESC was used. Two reviewers independently assessed the articles using the CASPe (Critical Appraisal Skills Program in Spanish) tool. Results: The Nu-DESC is employed in different contexts such as the adult intensive care unit (ICU), post-anesthetic care unit (PACU), palliative care unit, and hospitalization unit. It is more frequently used in the PACU with a more sensitive threshold (≥ 1); the test showed greater sensitivity of 54.5 % (95 % CI: 32.2–75.6) and specificity of 97.1 % (95 % CI: 95.3–98.4). Conclusion: The Nu-DESC facilitates the recognition of delirium episodes by the nursing team, makes care quicker and individualized for each patient, avoiding immediate pharmacological interventions, and coordinate interdisciplinary actions for diagnosis, especially in post-anesthetic care units.

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Asher, Mary E. "Cross-cultural comparison of perianesthesia nursing: Challenges encountered in the PACU." Journal of PeriAnesthesia Nursing 18, no. 1 (February 2003): 4–7. http://dx.doi.org/10.1053/jpan.2003.50001.

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Fitts, Summer, Serah Nyaga, Grace Umutesi, Matthew McEvoy, and Mark Newton. "PACU Pioneers Around the World: Nursing Quality Improvement Strategies in Kenya." Journal of PeriAnesthesia Nursing 34, no. 4 (August 2019): e49. http://dx.doi.org/10.1016/j.jopan.2019.05.116.

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Gao, Jingnan, Qiao Zheng, Mingmin Liu, and Jie Bao. "Functional Magnetic Resonance Imaging of Brain Function and Emergence Agitation of Patients with Dexmedetomidine-Assisted General Anesthesia under Comfortable Nursing Intervention." Computational Intelligence and Neuroscience 2022 (July 19, 2022): 1–8. http://dx.doi.org/10.1155/2022/8527568.

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In order to explore the effects of dexmedetomidine (DEX) on functional magnetic resonance imaging (fMRI) and emergence agitation of patients who underwent general anesthesia surgery with sevoflurane under comfortable nursing intervention, 66 patients who received upper abdominal surgery were selected as research objects. According to nursing and anesthesia methods, the patients were randomly divided into control group (routine nursing and anesthesia), group A (routine nursing and DEX-assisted anesthesia), and group B (comfortable nursing and DEX-assisted anesthesia). The differences in the brain fMRI characteristics, hemodynamic indexes, anesthesia recovery indexes, and nursing satisfaction in the perioperative period were evaluated. The results showed that the regional homogeneity values were different in different brain regions, but there was no difference in the Z value of functional connectivity P > 0.05 . Compared with the control group, heart rate, mean arterial pressure, awakening time, extubation time, the Riker sedation-agitation scale (SAS) score, and anesthetic dosage were signally decreased in group A and group B, while the Ramsay scores, the postanesthesia care unit (PACU) stay, and anesthesia maintenance time in the two groups was obviously increased P < 0.05 . Compared with group A, the extubation time, the SAS score, PACU stay, and hospital stay were all remarkably reduced in group B, while the nursing satisfaction score was greatly increased P < 0.05 . To sum up, DEX was helpful to safely and effectively reduce the occurrence of emergence agitation in patients under general anesthesia surgery with sevoflurane. Besides, comfortable nursing intervention could further reduce the incidence of emergence agitation in patients with general anesthesia, shorten the length of hospital stay, and improve nursing satisfaction.

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Boston, Lauren, Kathleen Gobbell, Jill McCann-Van Dokkum, Elizabeth Schwartz, and Raven Stafford. "Who's Who in the PACU? Role Designation During Emergencies." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e25. http://dx.doi.org/10.1016/j.jopan.2022.05.063.

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Wong, Diana, and Diala Epstein. "Increasing PACU Certification and Recognition During COVID-19 Pandemic." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e10-e11. http://dx.doi.org/10.1016/j.jopan.2022.05.028.

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Kaufman, Heidi, Brenda Hammes, Jesse Kane, Karen Kakizawa, Dennis McGlaughlin, Phillip Schmid, Kelly Shanahan, et al. "Aromatherapy in the PACU: Amazing Scents with Pleasing Benefits." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e22. http://dx.doi.org/10.1016/j.jopan.2022.05.058.

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Kent, Elaine. "Care of the High Dependency Patient." British Journal of Anaesthetic and Recovery Nursing 3, no. 2 (May 2002): 6–12. http://dx.doi.org/10.1017/s1742645600000863.

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ABSTRACTRecent government changes to Critical Care in the Health Service have resulted in an increase in the numbers of critical care patients being nursed in Post Anaesthetic Care Units (PACU). Many recovery nurses have had to increase their knowledge and skills accordingly. This article will analyse the high dependency nursing care given to a patient in the PACU necessitated by the haemodynamic compromise of the patient's cardiovascular system following surgery. The need for admission to a high dependency bed will be discussed along with the assessment of shock, tissue perfusion, fluid replacement, and any pharmacological intervention. Psychological, social and ethical issues relating to the patient and family will also be identified. Concentrating on the first 24 hours post-operatively, a careful discussion and analysis of the clinical management given will be made, with reference to the clinical and physiological measurements. After an evaluation and reflection of the medical and nursing care given to the patient, this article will conclude with a brief reiteration of the key issues.

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Luckowski, Amy. "Safety priorities in the PACU." Nursing 49, no. 4 (April 2019): 62–65. http://dx.doi.org/10.1097/01.nurse.0000554246.74635.e0.

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O'Brien, DD. "Review and update of neuromuscular blocking agents." Critical Care Nurse 9, no. 10 (November 1, 1989): 76–80. http://dx.doi.org/10.4037/ccn1989.9.10.76.

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The patient arriving in the PACU or ICU following surgery requires vigilant and intelligent nursing care. The postanesthesia nurse or critical care nurse with an understanding of the neuromuscular blocking agents used in anesthesia care is best prepared to observe, evaluate, and care for this patient.

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Derieg, Sarah, Regina Hoefner-Notz, and The PACU preceptor group. "The PACU: A New Approach to Increase Clinical Placements for Nursing Students." Journal of PeriAnesthesia Nursing 27, no. 3 (June 2012): e22-e23. http://dx.doi.org/10.1016/j.jopan.2012.04.093.

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Macas, Andrius, Lina Andriuškevičiūtė, Jūratė Paltanavičiūtė, and Ieva Slauzgalvytė. "Sedation in the post-anaesthesia care unit." Acta medica Lituanica 19, no. 3 (October 1, 2012): 195–200. http://dx.doi.org/10.6001/actamedica.v19i3.2448.

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Background. Post-anaesthetic sedation is a common practice as it pro vides greater comfort and psychological stability for patients. Some spe cialists claim that sedation in the post-anaesthetic care unit (PACU) is applied too seldom due to several reasons. The goal of this study is to evaluate sedation in PACU in several aspects. Materials and methods. A total of 299 patients admitted to the PACU after general, orthopedic-traumatologic or urologic surgical procedures were enrolled in this prospective study. The patients evaluated their qual ity of sleep and the worst intensity of pain experienced in PACU, which was assessed using the Numerical Rating Scale. Nurses evaluated sedation using the Motor Activity Assessment Scale and filled in the questionnaire about the importance of sedation. Results. Statistically significant difference was observed in the quality of sleep between the patients sedated using benzodiazepines and opioids together and non-sedated patients (p = 0.025). There is no considerable difference in the statistics concerning the behavior of the patients. The patients prescribed only with opioids IV or IM, as well as the patients prescribed with opioids together with benzodiazepines, feel less intense pain compared to the non-sedated patients (p = 0.016, p = 0.03). Accord ing to the personnel, sedation is necessary in PACU. Half of them think that patients prescribed with opioids need additional sedation. Conclusions. Sedation is necessary in PACU. This fact is evident in the statistically significant difference of comfort factors among the patients as well as in the opinion of the nursing personnel that spend most of the time communicating and caring about the comfort of the patients.

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Song, D., F. Chung, M. Ronayne, B. Ward, S. Yogendran, and C. Sibbick. "Fast-tracking (bypassing the PACU) does not reduce nursing workload after ambulatory surgery †." British Journal of Anaesthesia 93, no. 6 (December 2004): 768–74. http://dx.doi.org/10.1093/bja/aeh265.

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Tallman, Kristen, Satya Krishna Ramachandran, Robert Christensen, and Denise O’Brien. "Cardiac Arrest in the PACU: An Analysis of Evolving Challenges for Perianesthesia Nursing." Journal of PeriAnesthesia Nursing 26, no. 1 (February 2011): 4–8. http://dx.doi.org/10.1016/j.jopan.2010.10.002.

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Wiklund, Richard A. "Fast-Tracking (Bypassing the PACU) Does Not Reduce Nursing Workload After Ambulatory Surgery." Survey of Anesthesiology 49, no. 4 (August 2005): 179–80. http://dx.doi.org/10.1097/01.sa.0000172500.68487.eb.

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Ke, Yuhe, Sophia Chew, Edwin Seet, Wan Yi Wong, Vera Lim, Nelson Chua, Jinbin Zhang, et al. "Incidence and risk factors of delirium in post-anaesthesia care unit." Annals of the Academy of Medicine, Singapore 51, no. 2 (February 23, 2022): 87–95. http://dx.doi.org/10.47102/annals-acadmedsg.2021297.

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Introduction: Post-anaesthesia care unit (PACU) delirium is a potentially preventable condition that results in a significant long-term effect. In a multicentre prospective cohort study, we investigate the incidence and risk factors of postoperative delirium in elderly patients undergoing major non-cardiac surgery. Methods: Patients were consented and recruited from 4 major hospitals in Singapore. Research ethics approval was obtained. Patients older than 65 years undergoing non-cardiac surgery >2 hours were recruited. Baseline perioperative data were collected. Preoperative baseline cognition was obtained. Patients were assessed in the post-anaesthesia care unit for delirium 30–60 minutes after arrival using the Nursing Delirium Screening Scale (Nu-DESC). Results: Ninety-eight patients completed the study. Eleven patients (11.2%) had postoperative delirium. Patients who had PACU delirium were older (74.6±3.2 versus 70.6±4.4 years, P=0.005). Univariate analysis showed those who had PACU delirium are more likely to be ASA 3 (63.6% vs 31.0%, P=0.019), had estimated glomerular filtration rate (eGFR) of <60mL/min/1.73m2 (36.4% vs 10.6%, P=0.013), higher HbA1C value (7.8±1.2 vs 6.6±0.9, P=0.011), raised random blood glucose (10.0±5.0mmol/L vs 6.5±2.4mmol/L, P=0.0066), and moderate-severe depression (18.2% vs 1.1%, P=0.033). They are more likely to stay longer in hospital (median 8 days [range 4–18] vs 4 days [range 2–8], P=0.049). Raised random blood glucose is independently associated with increased PACU delirium on multivariate analysis. Conclusion: PACU delirium is common in elderly patients with risks factors presenting for major surgery. Keywords: Geriatrics, major non-cardiac surgery, postoperative delirium

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French, Katy E., Iris Recinos, Alexis B. Guzman, Thomas A. Aloia, Mike Hernandez, Spencer S. Kee, Alicia M. Kowalski, et al. "Continuous Quality Improvement Measured With Time-Driven Activity-Based Costing in an Outpatient Cancer Surgery Center." Journal of Oncology Practice 15, no. 2 (February 2019): e162-e168. http://dx.doi.org/10.1200/jop.18.00394.

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PURPOSE: As health care costs rise, continuous quality improvement and increased efficiency are crucial to reduce costs while providing high-quality care. Time-driven activity-based costing (TDABC) can help identify inefficiencies in processes of cancer care delivery. This study measured the process performance of Port-a-Cath placement in an outpatient cancer surgery center by using TDABC to evaluate patient care process. METHODS: Data were collected from the Anesthesia Information Management System database and OneConnect electronic health record (EHR) for Port-a-Cath cases performed throughout four phases: preintervention (phase I), postintervention, stabilization, and pre–new EHR (phases II and III), and post–new EHR (phase IV). TDABC methods were used to map and calculate process times and costs. RESULTS: Comparing all phases, as measured with TDABC methodology, a decrease in post-anesthesia care unit (PACU) length of stay (LOS) was identified (83 minutes v 67 minutes; P < .05). The decrease in PACU LOS correlated with increased efficiency and decreasing process costs and PACU nurse resource use by fast tracking patients for Port-a-Cath placement. Port-a-Cath placement success and the functionality of ports remained the same as patient experience improved. CONCLUSION: TDABC can be used to evaluate processes of care delivery to patients with cancer and to quantify changes made to those processes. Patients’ PACU LOS decreased on the basis of the 2013 Port-a-Cath process improvement initiative and after implementation of a new EHR, over the course of 3 years, as quantified by TDABC. TDABC use can lead to improved efficiencies in patient care delivery that are quantifiable and measurable.

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Huang, Jin, Imelda DeCastro, Alita Campbell, Sudha Yalamanchili, David Reams, Staci Eguia, and Soo OK. "Essential Role of PACU Nursing in Developing and Sustaining a Multidisciplinary Enhanced Recovery Program." Journal of PeriAnesthesia Nursing 31, no. 4 (August 2016): e14. http://dx.doi.org/10.1016/j.jopan.2016.04.034.

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Sapikowski, Lucinda, Kate Bullock, Juleah Walsh, and Caren Alexander. "Implementation of a PACU Pause in a Pediatric Post Anesthesia Care Unit." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e12. http://dx.doi.org/10.1016/j.jopan.2022.05.032.

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Lewicki, Linda J., and Kay E. Fraulini. "After Anesthesia: A Guide for PACU, ICU, and Medical-Surgical Nurses." American Journal of Nursing 88, no. 5 (May 1988): 761. http://dx.doi.org/10.2307/3425951.

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Inch, Jessica. "The Implementation of a ‘Signs of Sepsis’ Learning Resource for a Post-Anaesthetic Care Unit." British Journal of Anaesthetic and Recovery Nursing 7, no. 3 (August 2006): 22–26. http://dx.doi.org/10.1017/s174264560600009x.

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The following article centres on the justification, planning and implementation of a ‘Sepsis Learning Package’ for nursing students and qualified practitioners. This takes the form of a CDROM and web site, and is concerned with the recently spotlighted area of severe sepsis recognition and the related physiology. This was initially utilised in an orthopaedic post-anaesthetic recovery unit (PACU) that doubles as a high-dependency area. This unit is prone to readmissions from the ward environment with ‘sepsis’ being among the many diagnoses. This therefore highlights the need for all staff, both ward and PACU, to recognise the signs and symptoms before the condition progresses. The unit greatly values the sharing of knowledge, in the form of group teaching sessions and scenarios. However, there was great potential for a separate vessel for learning that made use of the computers in the work environment and in turn provided some interesting advantages.

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Gomez, Hazzel. "Ensuring Successful Practice Using a PACU-Track-Specific Nurse Residency and Fellowship Program." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e18. http://dx.doi.org/10.1016/j.jopan.2022.05.046.

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Hsu, Team Leaders: Agnes, Marissa Aquino Gado, Team Members: Mary Ann Del Rosario, Soo L. Ok, and Benjamin G. Orbita. "Nursing Best Practice: Promoting Medication Safety on Commonly Used Medications in the Ambulatory Surgery PACU." Journal of PeriAnesthesia Nursing 36, no. 4 (August 2021): e5. http://dx.doi.org/10.1016/j.jopan.2021.06.020.

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Dureault, Kathy, Elizabeth J. Winokur, and Dana N. Rutledge. "Effects of Transport on Oral Temperature of Postsurgical Patients Transported from PACU to Nursing Units." Journal of PeriAnesthesia Nursing 35, no. 4 (August 2020): 413–16. http://dx.doi.org/10.1016/j.jopan.2020.02.002.

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Aguirre, A. G., J. Chen, A. Cooke, and J. Mourad. "Rates of Same Day Discharge Before and After PACU Nursing Education for Patients Undergoing Hysterectomy." Journal of Minimally Invasive Gynecology 25, no. 7 (November 2018): S95. http://dx.doi.org/10.1016/j.jmig.2018.09.195.

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Saraceni, Maria, Jolanta Zabielska, and Maria del Mar Rodriguez. "Improving Nursing Compliance with Prescribed Respiratory Therapy in the PACU: Incentive Spirometry, Cough and Deep Breathing." Journal of PeriAnesthesia Nursing 37, no. 4 (August 2022): e20-e21. http://dx.doi.org/10.1016/j.jopan.2022.05.054.

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