Discharge Criteria of Patient from
Title
Post Anesthesia Care Unit
CONTENT :
This policy describes the discharge criteria of patient from Post Anesthesia Care Unit.
PURPOSE :
To safely facilitate the discharge of patients from Post Anesthesia Care.
DEFINITION :
A. PACU (Post Anesthesia Care Unit) – is a unit in the hospital where patients are brought
after surgery to regain consciousness from anesthesia and receive an appropriate post-
operative care.
B. General Anesthesia – is a medically induced unconsciousness with loss of reflexes and
absence of pain sensation all over the body as a result of administration of one or more
general anesthetic agents.
C. Epidural Anesthesia – is produced by the injection of an anesthetic agent into the
epidural space which eliminates or blocks sensation in a certain part of the body. This is
often used during childbirth.
D. Spinal Anesthesia – is a form of regional anesthesia by injecting local anesthetic into the
subarachnoid space.
E. Local anesthesia – a type of anesthesia which induces loss of sensation in a specific
part of the body without loss of consciousness.
SCOPE:
A. Anesthesiologist
B. PACU nurse
POLICY:
A. PACU nurses may discharge a patient when:
1) The patient meets the PACU Discharge Assessment Criteria.
2) Patients must have a Aldrete Score “9/10” to be discharged from PACU unless
otherwise approved by the Anesthesiologist.
3) If the patient does not meet the PACU Discharge Assessment Criteria, the
anesthesiologist must assess the patient prior to discharge.
PROCEDURE:
A. Assess the patient’s status before discharge using the following criteria:
1) Consciousness Level
- The patient is fully conscious and oriented, able to maintain his own airway
and able to use his reflexes.
2) Respiration
- Respiratory function and good oxygenation should be maintained with no
difficulty of breathing.
- The patient should have a respiratory rate of 10-20 beats per minute for
adult, 20-30 cycles per minute for pediatric patients.
- The patient’s oxygen saturation (SpO2) should be more than 95% on air,
unless there is history of lung disease.
3) Circulation
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- The blood pressure and pulse rate should be within the normal preoperative
reading.
- The patient’s blood pressure should be within 10-20 % of his/her
preoperative baseline reading.
- Heart rate should be within 60-90 beats per minute for adult and 80-120
beats for pediatric patients.
4) Color
- Patient’s skin color should be pinkish and warm to touch.
- It should not be cyanotic or cold clammy.
5) Activity
- Patient can follow command and able to execute purposeful movement.
6) Surgical Site
- Dressing is dry and intact
- Drains are patent and with acceptable amount of drainage.
- Excessive or sanguineous drainage must be reported to the surgeon as
may indicate bleeding.
7) Pain
- Patient should be able to deep breath and cough without severe pain.
- Intense and / or unexplained pain has been reported to the Anesthesiologist
and/or Surgeon.
.
8) Nausea and Vomiting
- Nausea or vomiting is to be controlled by anti-emetic medications as
prescribed by the anesthetist.
9) Temperature
- A temperature must be done within 15 minutes prior to discharge.
- Patient’s temperature should be greater than 36 degrees Celcius
10) Fluid Balance
- Urinary output should be a minimum of 30ml/hr, if a patient has a urinary
catheter in situ.
NOTE: It does not apply to patient with continuous bladder irrigation.
- Fluid loss and replacement should be accurately documented.
NOTE: Spinal and Epidural Anesthesia:
Patient that have received spinal or epidural anesthesia must be able to
band knees and lift buttocks.
ATTACHMENT:
A. Aldrete Scoring
REFERENCE:
Discharge Following Surgery Clinical Guideline
PACU Discharge Criteria. Sunnybrook Health Sciences Centre
REVISION:
New Policy
DISTRIBUTION:
Available on eManuals
Signed original is maintained in the Quality Department
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Recommended by: Date: 15.12.2016
Reviewed by: Date: 15.12.2016
Reviewed by: Date: 15.12.2016
Reviewed by: Date: 15.12.2016
Reviewed by: Date: 15.12.2016
Approved by: Date: 15.12.2016
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