Recovery Room/Post Anaesthesia Care Unit (PACU)

Structure

1. 1. It should be located close to the operating suite to permit anaesthesiologists and surgeons to be nearby and allow rapid return of the patient to the operating room if necessary. It is also useful to have the recovery room located near to the ICU.
   2. The size of the recovery room is determined by the surgical caseload of the institution. The number of bed/trolley spaces must be sufficient for expected peak loads and there should be not less than 1.5 bed spaces per operating room. The space allocated per bed/trolley
      should be 9 to 12 square metres with easy access to the head of the patient.
   3. It should have large doors, adequate lighting, and sufficient electrical socket points and water point /sink.
   4. There should be a central nursing station as well as space for storage of equipment and drugs room. An open ward is optimal for patient observation; however, at least one isolation room is a helpful addition to every PACU for the management of patients with either contaminated wounds or severe immunosuppression.

Facilities

1. 1. Each bed space must be provided with a monitor (NIBP, ECG, SPO2, temperature), an oxygen source, two general power outlets, adequate lighting.
   2. There should be a wall clock with a sweep second hand or digital equivalent clearly visible from each bed space.
   3. Communication facilities- An emergency call system and a telephone. Within the recovery room there must be stethoscope, suction machine a range of devices for the administration of oxygen to spontaneously breathing patients.
   4. A self-inflating manual resuscitator e.g. Ambu bag in order to deliver an oxygen enriched mixture for inflating the lungs.
   5. Equipment and drugs for airway management and endotracheal intubation as well as various sized oral and nasopharyngeal airways must be present.
   6. A well-stocked emergency difficult airway trolley in recovery is useful.
   7. Emergency drugs, a range of intravenous equipment and fluids and drugs for acute pain management should be on hand. Syringes and needles of varying sizes must also be stocked.
   8. Patient warming devices.
   9. There should be immediate access to a monitoring defibrillator preferably with pacing facility, a refrigerator for drugs and blood and a   procedure light.
   10. A surgical tray for procedures including tracheostomy and chest drains as well as point of care access to diagnostic services e.g. blood glucose, blood gas and portable XRAY.
   11. The recovery trolley/bed must have a firm base and mattress and must tilt from either end – both head up and head down – to at least 15 degrees and is easy to manoeuvre with functional and accessible brakes. It must also provide for sitting the patient up and have straps or side-rails which must be able to be dropped below the base or be easily removed. The trolley/bed must also have a pole from which intravenous solutions may be suspended.

Staffing

1. 1. It is the responsibility of the institution to ensure that the staff appointed to the recovery room is trained and competent. The recovery staff must be available at all times.
   2. A nurse trained and competent in recovery room care must be present at all times. An appropriately trained registered nurse experienced and competent recovery room work should be in charge.

Monitoring

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.
2. Observations should be recorded at appropriate intervals and should include at least, state of consciousness, colour, respiratory rate, oxygen saturation, pulse and blood pressure and level of pain.
3. The record should form part of the patient’s clinical notes. All patients should remain until the anaesthesiologist considers it safe to discharge them from the recovery room, according to validated criteria, which includes the return of protective airway reflexes, stable cardiovascular and respiratory function, full reversal of neuromuscular blockade, absence of nausea and vomiting and absence of pain. Use of anappropriate PACU scoring system is encouraged for each patient on admission, at appropriate intervals prior to discharge and at the time of discharge.
4. The anaesthesia care provider is responsible for accompanying the patient to the recovery room and adequately handing him/her over to the nursing staff who will document the patient’s condition on arrival and subsequent course in recovery.
5. The anaesthesia care provider/member of the Anaesthesia Care Team shall remain in the PACU until the PACU nurse accepts responsibility for the nursing care of the patient, or delegates this responsibility to another anaesthesiologist or intensivist/medical officer who will supervise the recovery period and authorize the patient’s discharge.
6. When discharge criteria are used, they must be approved by the Department of Anaesthesiology and the medical staff. They may vary depending on whether the patient is discharged to a hospital room, to the ICU, to a short stay ward or home. In the absence of a 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.