Clinical Guideline

RECOVERY DISCHARGE CRITERIA

SETTING Bristol Royal Hospital for Children (BRHC)

FOR STAFF Theatre/Recovery/Ward Staff

PATIENTS To ensure all patients are safely discharged from recovery to the appropriate
ward.

_____________________________________________________________________________

GUIDANCE
CRITERIA FOR DISCHARGE FROM RECOVERY

Airway: Unobstructed and clear of secretions and blood. Persisting obstruction or stridor needs
review, treatment if needed and evidence of improvement / stabilisation.

Breathing: Respiratory rate within normal limits for age of patient. Haemoglobin oxygen
saturation 94% or greater. Oxygen prescribed if needed. If pre-existing cyanosis due to cardio-
respiratory disease, saturations must be within set limits; these are to be recorded by
anaesthetist or responsible physician / surgeon. Any evidence of respiratory distress needs
prompt action and review.

Circulation: Pulse rate, blood pressure and peripheral perfusion within normal limits for age or
return to stable preoperative baseline or in keeping with planned / expected postoperative
conditions. Planned/expected Ranges recorded. Minimal on-going bleeding. Distal Capillary refill
<2 Seconds.

Conscious Level: Awake or responsive to voice, with minimal stimulation. If patient has
impaired conscious level, a return to preoperative baseline or in keeping with expected
postoperative course. Neurosurgical patients to have additional observations documented that
are to be within agreed limits set by Surgeon or Anaesthetist. Patient destination must be
suitable to care for patient with impaired conscious level. Discussion of required care must be
recorded.

Temperature: Should be within the range of 36 – 37.5º C. Patients must not be sent back to the
ward if temperature is below 36º C. If hypothermic, measures must be implemented to actively
warm patient and documented, with a record of the improvement before discharge. If pyrexial,
temperature should be stable or decreasing and measures should be in place to treat.

Pain: Patient must be comfortable with treated pain and low pain scores. All necessary
analgesics must be prescribed and checked including Patient controlled analgesia (PCA) /
epidural. All pump checks documented and additional epidural checks completed including,
Modified Bromage score, Dermatome Level and site check. Anti-emetics should be prescribed, if
appropriate, with accompanying saline flush. All Plaster casts / slings must be comfortable. If an
intravenous (IV) Opioid is given in recovery then child must remain for 20 minutes after last dose
given. Check naloxone is prescribed as an adjuvant for opioids.

Fluids: If needed, IV fluids need to be prescribed on appropriate chart and the pump set up with
fluids running. All drains, catheters, and infusions secure and in working order.
Version 2.2 From: Jun 19 – To: Jun 22 Author: Recovery Lead, Nurse Practice Group Page 1 of 2
Lines: Arterial lines to remain in situ and clearly labelled (if discharging to appropriate HDU) and
bandaged, or removed at the request of the anaesthetist and site checked. Central line secure,
dressed, not bleeding. Evidence of central line screened or x-rayed or plan in place to x-ray on
ward. Cannula sites to be checked / dressed / bandaged. All in-patients to have Microclave
extensions. Peripheral Intravenous Phlebitis Assessment (PIPA) Score carried out and cannula
care plan documentation completed for all in-patients.

Surgical Plan: Ensuring all relevant surgical plans are in place and a record of the
procedure/operation is in situ. Any immediate surgical requests are acted upon, and recorded.

Paperwork: All necessary documentation completed and signed including theatre / recovery
care plan, anaesthetic chart, operation note and prescription chart. All additional observations,
relevant to patient, completed. Ensure patient’s name band is in situ.

Review: If the Patient needs to be reviewed by the anaesthetist /surgeon prior to discharge, or if
this has been requested by anaesthetist /surgeon or deemed appropriate by recovery staff. The
outcome must be documented, detailing the plan of care.

If there is any doubt about a patient’s fitness for discharge the anaesthetist must be consulted.

_____________________________________________________________________________

RELATED Transfer Policy and Guidance:

DOCUMENTS http://nww.avon.nhs.uk/dms/download.aspx?did=8707
Recording Transfers of Patients Between Wards/Theatres/Hospital sites:
http://nww.avon.nhs.uk/dms/download.aspx?did=12630
Intravenous Fluid Administration:
http://nww.avon.nhs.uk/dms/download.aspx?did=13477
Acute Pain Management Guidelines:
http://nww.avon.nhs.uk/dms/download.aspx?did=5813
Tissue Viability Policy: http://nww.avon.nhs.uk/dms/download.aspx?did=11167
Assessment chart for wound management (child):
http://nww.avon.nhs.uk/dms/download.aspx?did=12560
Assessment chart for wound management (baby):
http://nww.avon.nhs.uk/dms/download.aspx?did=12559

AUTHORISING Nurse Practice Group

BODY

SAFETY If there is any doubt about a patient’s fitness for discharge the anaesthetist
must be consulted and outcome recorded.
Consider 2222 for emergency assistance.

QUERIES Recovery Lead

Anaesthetic and Recovery Manager
Consultant Paediatric Anaesthetists
Pain team
Childrens Critical Care Outreach team

Version 2.2 From: Jun 19 – To: Jun 22 Author: Recovery Lead, Nurse Practice Group Page 2 of 2