The PeriAnesthesia Care Pathway

Post Anesthesia Monitoring &

Nursing Documentation:

A Comprehensive Transfer Of Accountability

Special Thanks:

We would like to acknowledge the many hours of collaboration put forth by: Sirkka Roman-Fanon, RN, Margaret D’Addamio, RN, Deborah Mulgrave,

RN

Panel: Carol Deriet, Lynn Haslam, Ramona Hackett

What is a ‘care pathway’?

Background

• Secondary to a number of post operative adverse events and near misses Sunnybrook nursing representatives formed a Post Operative Monitoring Committee.

• It was recognized that previous nursing documents required improvement.

• The committee reviewed post operative monitoring guidelines by conducting a literature search, and examining current nursing documentation and communication processes.

• The committee‘s goal was to ensure that the most recent guidelines and validated assessment tools were being utilized.

Development Process

Layout of the document

Step 1 – Pre Op Admission clinic

Bottom of first page

Phase 1 recovery

Whites criteria

Also incorporated into the PACU Phase 1 documentation: Intake & Output Medication Record Transfer of Accountability sign off Shared space for narrative notes

Phase 2 recovery

Simplified documentation

Post operative Monitoring

If, after troubleshooting the patient still has respiratory issues, escalate care to appropriate person

Remember, high risk patients have probable sleep apnea! Even when VS are q4h, it is important to continue monitoring their respiratory pattern and quality at more regular intervals. These patients have had anesthesia and analgesia!

Processes

Documentation

Best practices & initiatives utilized:

Implementation

“The Road to Recovery” were sponsored by SHSC and OPANA

Challenges