Moffitt PACU Survival Tips

PLEASE READ THIS BEFORE YOU START THE ROTATION!

Welcome to the PACU rotation!  The next two weeks will be filled with varied clinical experiences that highlight the increasing importance of our role as perioperative physicians.

Your main responsibility, as the ML-PACU Resident, is to be the primary provider for adult patients in the recovery room as they transition from the operating room to an appropriate discharge location. On rare occasions you may be asked to look after a patient in the ML preoperative waiting area.  We expect this to be an enjoyable and educational two weeks in which you’ll increase your knowledge and understanding of post-anesthetic perioperative care.

 

Working hours:

The PACU shift starts at 12:00 noon on Mondays, Tuesdays, Thursdays, and Fridays. On Wednesdays, please attend the normally scheduled Grand Rounds/M&M/lecture and report to the PACU attending around 8:00 am. The attending will then determine whether or not you are needed at this time and may send you for some individual studying. If this is the case, please return to the PACU at 12:00 noon to resume your duty.

The PACU shift ends at approximately 20:00 after you have signed out to the E1pm attending. Please touch base with the E1pm attending around 19:45 to give report and round on the patients you are concerned about. There are times the PACU shift will extend beyond 20:00, particularly if there are critical issues with patients or the E1pm is unable to sign out at that time. While there is no PACU weekend or holiday call you are still part of the general resident call pool so be sure to check your schedule.

 

Responsibilities:

While you are in the PACU, your primary responsibility is patient care as you provide a continuation of anesthesia care after the OR team.  Typically, the PACU resident manages oxygenation and ventilation issues, pain management and vascular access.  However, there are situations when the PACU nurses need urgent assistance or the primary service is unavailable.  In general, we strive to do whatever is best for the patient and discuss with the primary team afterwards as necessary.  The PACU is a place where many Near Misses and M&M reports can be generated, keep your eyes open.

When the hospital census is high and there are no ICU beds available, ICU patients will be cared for in the PACU.  Although these patients are officially covered by the ICU team, the team is often taking care of other very sick patients many floors away.  Pay special attention to the ICU patients and call the ICU team as needed with any changes to the patient’s status.

As the PACU resident, you will interface with many providers taking care of the patient including the PACU and floor nurses, the OR team, the surgery team, respiratory therapists, etc.  With the multiple transitions of care during the postoperative time, communication is key. This is an excellent rotation to focus on safe handoffs, closed loop communication, and professional interactions with our colleagues.

Lastly, please make sure all the patients have an Anesthesia Post Op note completed before they leave the PACU.  This note is a mandatory step before the nurses are able to discharge the patients to the floor or home.  It can be frustrating to be paged or called about a post op note, but this is to ensure an anesthesiologist has evaluated the patient and deemed them safe to be discharged from the PACU.

 

Scholarly activities:

During your two week PACU rotation, it is expected that you complete one of three scholarly activities listed below.  Please check with the PACU attending early on in your rotation to arrange an appropriate time for your presentation.  The audience for your presentations will include the PACU attending, the regional anesthesia resident and the two pain residents. Other residents may want to join, especially if they were involved in the case in the OR.

1.    Present a “Case of the rotation”.  Choose any case that you found interesting and educational and present what happened followed by your differential and a brief review of the literature.  The best format would be a PowerPoint/keynote presentation for 15-20 minutes.

2.    Work on a topic for the PACU wiki.  We are in the process of setting up a PACU wiki with frequently encountered postoperative issues.  This site will contain many aspects related to PACU patient care.  Choose any of the topics to create or update and present your wiki chapter at the end of the rotation.

3.    Give an in-service to the PACU nurses.  The PACU nurses have expressed interest in learning more about certain commonly encountered topics in the PACU, such as epidurals, peripheral nerve blocks, updates on antiemetics, ketamine infusions, etc.  This in-service time would be a great opportunity to inform and discount misconceptions.  The lectures would be done on the first, second, or third Wednesday of the month around 9:00 am.

 

Feedback for anesthesia providers:

The PACU rotation has many unique learning opportunities.  You will see the decisions made in the OR play out postoperatively. It is a great learning experience and also a great chance to share this experience and knowledge with the people involved in the patient’s care.  We encourage you to give feedback to the intraop anesthesia team or regional team whenever you deem necessary and adequate.

Please discuss the case in question first with your PACU attending.  You should then meet the OR anesthesia provider either with or without your attending and discuss things in a nonjudgmental way.  This feedback is certainly not meant to undermine the current M&M or near-miss reporting system, but situations such as non-functional epidurals/nerve blocks, protracted nausea and vomiting, hypotension, or postoperative pain in chronic pain patients who did not take their home medications would be important to discuss with the primary OR team.

 

ML-PACU RESIDENT RESPONSIBILITIES AND EXPECTATIONS

·      Be on time to cover the PACU shift from 12:00 noon to 8:00 pm

·      Write your name and pager number on the whiteboard behind the PACU front desk (if you put the start and end day of your rotation behind your name, it usually does not get erased)

·      Round frequently to get as much information as possible first hand from the anesthesia provider who brings the patient out

·      Take care of all issues you feel comfortable with, but don’t hesitate to page your attending for a second opinion or to give you a hand

·      This is a great rotation to focus on safe handoffs, closed loop communication, and professional interactions with our colleagues. Please don’t hesitate to involve the attending when you feel patient care is being compromised.

 

 Rev. 08/2018 Matthias Braehler

Location: 
Clinical Area: 
Type: 

 

This information is meant to serve as an educational resource. Clinicians should use their own professional judgment in the care of any individual patient as the guidance contained in this document may not be appropriate for all patients or all situations.