BAUTISTA, Jesther Rowen
BAUTISTA, JESTHER ROWEN B.BSN IV-1LMC PACU 2-10
Decrease recovery time with proper pain management
Karin S. Nevius RN, CCRN, CPAN, BSN and Yvonne D'Arcy CRNP, CNS, MS
November 2008 Volume 39 Number 11 Pages 26 ± 32
Since their inception in the early 1960s, outpatient surgical centers now offer improvedtechnology and better anesthesia and pain control for less invasive surgical procedures. Theoption to return home after undergoing a procedure is attractive to many patients, as evidencedby the tremendous growth of outpatient surgical centers in the past few years. In 2006, thenumber of outpatient surgical centers rose 25% from 2001. The number of ambulatory carecenters registered with Medicare total more than 4,000, with the number of proceduresperformed yearly approaching 16,000,000 in free-standing ambulatory surgery centers.If postop nausea and vomiting (PONV) can be controlled and oral pain medications well-tolerated, patients can leave the surgery center. Well-managed pain can help shorten healingtime and return a patient to normal activity faster. When pain is poorly controlled and PONVdifficult to manage, the outcome of the procedure may include an admission to a 24-hour careunit to allow the patient to recover sufficiently enough to return home.
Postoperative levels of care
Some of the most common outpatient surgeries are: knee arthroscopies, liposuction andfacial procedures, cataract surgeries, tonsillectomies, gynecologic surgeries, and various typesof biopsies. Because of the variety of procedures and types of surgeries, nurses who care for patients in the ambulatory surgery setting must be proficient and knowledgeable about a largenumber of patient types. To define and differentiate the nurse's role in the PACU from other practice areas in the OR, the American Society of PeriAnesthesia Nurses (ASPAN) hasdeveloped criteria and levels of care specific to the postop period.Postop care is divided into postanesthesia Phase I or Phase II according to ASPANdesignations. Nursing responsibilities during Phase I center on transitioning the patient from ananesthetized state to care in Phase II or an inpatient setting. Assessment focuses on therespiratory and cardiovascular systems. Phase II focuses on preparing the patient and family for care in the home. Criteria for ambulatory surgical patients to be discharged from Phase II tohome include:* control of pain acceptable to the patient* control of nausea/vomiting* patient is ambulatory based on type of procedure and prior ability.Many ambulatory care patients move directly from the OR to Phase II. This practice of "fast-tracking" refers to bypassing Phase I. Contributing factors to fast-tracking are: