PACU STANDARDS

The ASA has Standards for Postanesthesia Care, updated in October 1994, by the ASA House of Delegates^[56] : These Standards apply to postanesthesia care in all locations. These Standards may be exceeded based on the judgment of the responsible anesthesiologist. They are intended to encourage quality patient care, but cannot guarantee any specific patient outcome. They are subject to revision from time to time as warranted by the evolution of technology and practice. Under extenuating circumstances, the responsible anesthesiologist may waive the requirements marked with an asterisk;* it is recommended that when this is done, it should be so stated (including the reasons) in a note in the patient's medical record.

Standard I

All patients who have received general anesthesia, regional anesthesia or monitored anesthesia care shall receive appropriate postanesthesia management.

1. A PACU or an area which provides equivalent postanesthesia care shall be available to receive patients after anesthesia care. All patients who receive anesthesia care shall be admitted to the PACU or its equivalent except by specific order of the anesthesiologist responsible for the patient's care.
2. The medical aspects of care in the PACU shall be governed by policies and procedures, which have been reviewed and approved by the Department of Anesthesiology.

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3. The design, equipment and staffing of the PACU shall meet requirements of the facility's accrediting and licensing bodies.

Standard II

A patient transported to the PACU shall be accompanied by a member of the Anesthesia Care Team who is knowledgeable about the patient's condition. The patient shall be continually evaluated and treated during transport with monitoring and support appropriate to the patient's condition.

Standard III

Upon arrival in the PACU, the patient shall be re-evaluated and a verbal report provided to the responsible PACU nurse by the member of the Anesthesia Care Team who accompanies the patient.

1. The patient's status on arrival in the PACU shall be documented.
2. Information concerning the preoperative condition and the surgical/anesthetic course shall be transmitted to the PACU nurse.
3. The member of the Anesthesia Care Team shall remain in the PACU until the PACU nurse accepts responsibility for the nursing care of the patient.

Standard IV

The patient's condition shall be evaluated continually in the PACU.

1. The patient shall be observed and monitored by methods appropriate to the patient's medical condition. Particular attention should be given to monitoring oxygenation, ventilation, circulation and temperature. During recovery from all anesthetics, a quantitative method of assessing oxygenation such as pulse oximetry shall be employed in the initial phase of recovery.* This is not intended for application during the recovery of the obstetrical patient in whom regional anesthesia was used for labor and vaginal delivery.
2. An accurate written report of the PACU period shall be maintained. Use of an appropriate PACU scoring system is encouraged for each patient on admission, at appropriate intervals prior to discharge and at the time of discharge.
3. General medical supervision and coordination of patient care in the PACU should be the responsibility of an anesthesiologist.
4. There shall be a policy to assure the availability in the facility of a physician capable of managing complications and providing cardiopulmonary resuscitation for patients in the PACU.

Standard V

A physician is responsible for the discharge of the patient from the PACU.

1. When discharge criteria are used, they must be approved by the Department of Anesthesiology and the medical staff. They may vary depending upon whether the patient is discharged to a hospital room, to the Intensive Care Unit, to a short stay unit or home.
2. In the absence of the physician responsible for the discharge, the PACU nurse shall determine that the patient meets the discharge criteria. The name of the physician accepting responsibility for discharge shall be noted on the record.