PACU Daily Responsibilities
- The resident is expected to be available starting at 7 am.
- The resident is expected to work closely and coordinate with the nursing team to manage the patient while they remain in PACU. Please ensure your team of PACU nurses knows who you are. They are an integral part of the healthcare team.
- Place your name, attending’s name, and your phone number on the whiteboard so the PACU nurses can contact you. NT has a dedicated phone for the PACU resident. ST and HVN share a phone, but in reality the provider should leave cell phone.
- The resident is expected to see and write post-op notes on all patients on the floor and ICU that bypassed PACU the previous day. This is typically completed first thing in the morning prior to patients arriving in the PACU for that day.
- Below are the instructions to access the post-op list for the respective tower you are in (NT, ST, or HVN).
- Smile! Remember that you are the first provider the patient will remember after emergence.
Post-op ICU Patients: Epic Instructions
- Login to Epic.
- On your status board page, near the top left of the screen (just under the Epic pull down menu) will be an option for “My Dashboards.” Click on that.
- You want to be in the “Gnv Anes Provider” dashboard.
- On the top right of the “Gnv Anes Provider” dashboard, there is a menu option called “Pts Missing Post-Op Evals North-South Towers.” You have to hover with your cursor to the right of this for the four option menu to pop up. Click “Refresh” for this report which is the 1st option.
- Next, click “Run Report” for this report.
- Wait anywhere from 30 seconds to 5 minutes for this report to run.
- Click “View Report” and the report of patients missing post-op evaluations in the North, South, and HVN towers will appear.
- Sort through the list to find the patients missing post-ops for North, South, or HVN tower (depending on your assignment) and see the patient.
- If a potential anesthesia related post-operative complication is identified notify the attending anesthesiologist on record to ensure proper follow-up.
- All residents, CRNAs and AAs are encouraged to follow-up with their own patients, but the ICU patient post-op notes are written by the PACU resident to ensure documentation compliance.
- The ideal time to complete these notes is between 8-9AM after OR cases have started and prior to patient arrival in PACU.
- One more detail: after completing the post-op notes that you write, please CLOSE OUT THE ENCOUNTER if all activities are completed so it is “close out-able” (i.e., all the dots green).
Typical Daytime Flow
- Admit patients to your assigned NT, ST, HVN PACU from the OR and receive sign-out from residents/CRNA’s/AA’s when the patient arrives in the PACU
- Place orders and complete Aldrete score for the AA’s, as they cannot write orders for their patients.
- If you have any problems with a PACU patient, contact the primary attending on record. If not available, contact the assigned anesthesiology attending to PACU
- Manage common postoperative care issues and reference the white folder near your station that contains peer reviewed articles regarding standards of care and treatment strategies.
- Sign out all PACU patients:
- Complete another Aldrete score when patient is ready for discharge.
- Complete a post-anesthesia evaluation note.
- Do a med-reconciliation and discontinue all PACU orders.
- The steps to discontinue EPIC orders include:
- Go to order review
- View by phase of care
- Select orders by PACU phase of care
- Select discontinue
- Place a discharge order to the floor or home (use the “Discharge from PACU “IP” order-set)
- At the end of the day, usually around 5:30, the mole team will be taking over. Coordinate with the AOD and MOLE team to sign-out your PACU patients. You will be relieved when the AOD and mole team feel they have sufficient coverage.
- A couple of issues keep coming up in the transition from “resident covering the PACU patients” to “night coverage for the PACU patients.” They are as follows:
- Finish any post-ops prior to leaving. Do not leave them for the mole team to finish.
- At the end of your day, have a “FACE-TO-FACE” with the AOD to find out to whom you are going to pass the PACU phone and the responsibility for the PACU patients. It’s very important to have a “FACE-TO-FACE” with your relief.
When asked to perform preops / consents for cases for the next day, you can find the list through the “more reports” tab, followed by “T+1 PO Print.”
This will show all of the cases posted for the next day that are in house that still require either a preop note, a consent, or both. A chart / sticky note indicates they have a note already. Once they have both a note and a consent, they will drop off of this list.
The following ICUs correlate with the Patient Location:
- Burn / ENT 24**/25**
- NICU 3*****
- MICU 82**
- PICU 10-4***
- CHICU 10-2***
- SICU 4***
- Vascular 46**
- Neuro 47**
- CV 77**
- Thoracic 87**
Some patients, such as burns (24**/25**), ECT, or pediatrics (such as those having intrathecal chemo) will have many repeat procedures. In these cases, we need to use a Multiple Procedure Consent form. If none are available in the respective AOD offices, more of these consent forms can be found on the bridge. You can find a link to the UF Anesthesia bridge at the bottom of the UF Anesthesia home page.
Once on the bridge, click on the “Clinical” tab, followed by the “Forms and Consents” tab.
When asked to do a PACU signout, you need to physically go to the appropriate PACU (NT / ST / HVN) and ask the nursing staff which patients need a sign out. You then must physically see the patient, evaluate their hemodynamic stability, status of pain, nausea, and vomiting, whether they have tolerated anything by mouth, if they have voided, and if there were any significant orders from their PACU stay (such as initiating pressors, transfusing blood products, upgrade in level of care, etc).
You can find the PACU section of the anesthetic record by clicking on the Postprocedure tab.
Find the section labeled “Postprocedure Evaluations” and click “Create Note.” Select the default option, which will bring up the following note template. Fill it out and sign the note.
To place an Aldrete documentation, find the section labeled “Aldrete” (still within the Postprocedure tab) and click “New Reading.” Fill out the template boxes as indicated.
To complete a PACU signout, you must ALSO place orders for discharge. Go to the “Order Sets” tab and select “Discharge/transition from PACU Adult and Pediatric UF IP” (if you don’t have this saved as a favorite yet, you can simply search for Order Sets.
You then must click the appropriate box based on whether the patient is discharging home or to the floor.
You can then find the “Sign Record” section and if every check list is met, you can sign the record to fully close it out. If certain check marks have not been completed (such as Attending Attestation Missing), you don’t need to worry about it. As long as the note, Aldrete, and orders are complete, you’ve successfully signed someone out of PACU!