In this section
Routine post anaesthetic observations are an requirement for patient assessment and the recognition of clinical deterioration in post-operative patients; acknowledging that children are at a high risk of complications post anesthetics, surgeries and procedures. There is disparity in the literature as to what constitutes ‘standard’ routine post anaesthesia observations, so in line with the Observation and Continuous Monitoring Guideline, this guideline designates clinical observations for the immediate post-operative period and assists in the recognition of clinical deterioration through use of the Victorian Children’s Observation and Response (ViCTOR) graph containing unshaded zones in which normal observations are expected and shaded zones above and below the normal limits..
This guideline applies to all patients after a general anaesthetic for whom the ‘Post-Operative Discharge Criteria Following General Anaesthesia for Minor Surgical Procedures’ does not apply.
This guideline provides guidance for:
Note that this is a guideline only and does not replace the need for clinical judgment on an individual basis.
When admitting a patient to PACU patient identification and handover should occur utilising the Handover Flowsheet. Post-operative orders must be communicated both verbally and documented in the EMR. Post-operative orders are additional to the operation report. Clinical handover should highlight any issues throughout the intra-operative period, acknowledge the process for escalation of care, should this be required and allow for clarification of any instructions before accepting care of the patient. Once care is accepted in the PACU the initial assessment should include:
continue at least 15 minutely, or more frequently as clinically
Continuous Oximetry monitoring should be initiated for all patients admitted to PACUCardiorespiratory monitoring should be applied to all patients under 6 months of age and as clinically indicated for all other patients
Patients are ready to transfer to the ward once they meet the PACU ‘Discharge Criteria’ (see below) and ‘Ready for Discharge’ both of which are timestamped on EMR.
If there is a delay in transfer of patient related to inability of inpatient unit to accept care, then observations in the PACU will continue to be 15 minutely as per ACORN standards.If there is a delay in transfer PACU nurses will handover the time the patient met the PACU ‘Discharge Criteria’.
Please refer to ‘Post-Operative Discharge Criteria Following General Anaesthesia for Minor Surgical Procedures’ for day of surgery patients. When transferring care from PACU to the ward, patient identification and handover should occur utilising the Handover Flowsheet. Initial patient assessment should include:
The time frame for routine post anaesthetic observations should commence once the PACU nurse has deemed the patient ‘Ready for Discharge’. See special considerations for how to locate this on EMR.Note: if there is a delay in transferring a patient to the ward due to bed availability, the time the patient met the PACU ‘Discharge Criteria’ and ‘Ready for Discharge’ should be noted, so as the routine post anaesthetic observation period need not be reset.
Consider the need for continuous pulse oximetry and/or cardio-respiratory monitoring as indicated by patient’s condition. All Patients with altered conscious, respiratory and/or cardiovascular status should receive continuous pulse oximetry and/or cardio-respiratory monitoring throughout the routine post anaesthetic period outlined above and as indicated by patient condition.Refer to the Observation and Continuous Monitoring guideline for more information.Whilst all postoperative orders need to include both post anaesthetic and post-surgical orders, some patient groups may need modified post-operative orders +/- modification of MET criteria, these may include:
For further information regarding modification on the MET criteria please see the Medical Emergency Response Procedure.
At the completion of the RPAO’s, the type and frequency of clinical observations must reflect the clinical status, therapies and interventions being delivered to the child and be consistent with requirements of other individual guidelines and procedures.
Note, other children may require hourly observations and continuous monitoring as clinically indicated.
If you are concerned about the child for whom you are caring, please refer to the Medical Emergency Response Procedure. If immediate review is required in a deteriorating child, call a MET (dial 777 and state building, level, ward and room number).
Routine Post Anaesthetic Observation Guideline Evidence Table
Please remember to read the disclaimer
development of this nursing guideline was coordinated by Stacey Richards, Nursing Research, CNC,
and approved by the Nursing Clinical Effectiveness Committee. Updated November 2019.