In this section
Routine post anaesthetic observations are an essential requirement for patient assessment and the recognition of clinical deterioration in post-operative patients; acknowledging that children are at a higher risk of complications post anesthetics, surgeries and procedures. There is disparity in the literature as to what constitutes ‘standard’ routine post anaesthesia orders, so in line with the Observation and Continuous Monitoring Guideline, this guideline designates clinical observations for the immediate post operative period. Recognition of clinical deterioration is guided with use of the ViCTOR graph. It contains coloured zones in which normal observations are expected (white zone) or orange and purple zones which identify the observations that are above, or below, the normal limits. Clinical observations marked in the orange or purple zone indicate the level of urgency to review a child.
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 negate the need for clinical judgment on an individual basis.
On admission to the PACU (stage 1) post-operative orders must be communicated both verbally and documented in the EMR. Post-operative orders will be 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:
The following observations continue 15 minutely
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 ‘Recovery Care is completed’ 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.
The time frame for routine post anaesthetic observations should commence once the PACU nurse deems ‘Recovery Care Complete’ for the patient. This documentation is located in the EMR under ‘Chart Review’ Activity – ‘Theatre and Anaesthetics’ tab – ‘Operation’ – ‘Recovery Summary’. This is likely to be the time that PACU phones the ward to request they accept care of the patient. The ward nurse should confirm the time when the patient was deemed ‘Recovery Care Complete’ during handover. Note: if there is a delay in transferring the patient to the ward due to bed availability, the time the patient met the PACU ‘Discharge Criteria’ and ‘Recovery Care Complete’ should be noted, so as the routine post anaesthetic observations period need not be reset.When transferring care from PACU to the ward the initial assessment should include:
Frequency of routine post anaesthetic observations:
Routine post anaesthetic observations should include:
Routine post anaesthetic observations should include:Consider the need for continuous pulse oximetry and/or cardio-respiratory monitoring as indicated by patient’s condition. All Patients with altered conscious, respiratory, 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 & continuous monitoring clinical guideline.
If the patient has been administered Flumanezil or Naloxone in either theatre or recovery this increases their risk of adverse complication/event such as respiratory depression/compromise and increase sedation/or altered conscious state.
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 Emergency Response Criteria these may include:
For further information regarding modification on the Emergency Response 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 therapies and interventions being delivered to the child and be consistent with requirements of other individual guidelines and procedures.
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, Nurse Educator, Undergraduate Nurses,
and approved by the Nursing Clinical Effectiveness Committee. Updated October 2016.