How do you do post-anethesia evaluations?

[nutmegs]

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CMS guidelines for post-anesthesia evaluations have recently changed. To be in compliance:

- patients must be evaluated before discharge home (outpatients) or within 48 hours of transport to the designated recovery area (inpatients)
- evaluation must be done by someone qualified to provide anesthesia
- patient must be sufficiently recovered to answer questions appropriately and perform simple tasks
- the following elements must be documented: respiratory function (including rate, airway patency, and SpO2), CV function (including pulse rate and BP), mental status, temperature, pain, nausea/vomiting, and hydration. Additional types of monitoring or assessment may be required for specific surgeries/procedures.
- except in cases where post-operative sedation is necessary for the optimum medical care of the patient (e.g., ICU), the evaluation generally would not be performed immediately at the point of movement from the operative area to the designated recovery area.


My question is, how is this accomplished at your place of work or training?
- are you in PP or academics?
- who does these evaluations on weekdays? on weekends?
- when/how do you evaluate patients who are transported to the ICU intubated? (the guidelines appear to conflict on this)
- how do you make sure ICU patients get seen?
- where do you document this evaluation?

Thanks in advance for your input.

 

[hoyden]

PP. There is a small box for this on our anesthesia record. It gets filled out at some point while they are in the PACU or ODS. If the patient is going to the ICU, it gets filled out immediately, when they get dropped off. You wrote yourself that ICU is an exception.

Same. Time put for additional evaluation might be even 1 minute after the end of your anesthesia time ( end of your PACU report), provided the pt is stable and communicative.

 

[Dryacku]

Same. Time put for additional evaluation might be even 1 minute after the end of your anesthesia time ( end of your PACU report), provided the pt is stable and communicative.

At our institution they require us to do the post op check the next day and done by the residents

This can be a real pain. Is there a way to provide some documentation to state it is okay to do the post op check in the PACU?

 

[nutmegs]

At our institution they require us to do the post op check the next day and done by the residents

This can be a real pain. Is there a way to provide some documentation to state it is okay to do the post op check in the PACU?

http://www.asahq.org/Washington/12-11-09 RevisedANHospitalInterpretiveGuidelines.pdf

 

[hoyden]

At our institution they require us to do the post op check the next day and done by the residents

This can be a real pain. Is there a way to provide some documentation to state it is okay to do the post op check in the PACU?

Same was when I was a resident... I am not anymore :🙂

 

[Dejavu]

Our EMR won't let the PACU nurses transfer the medical record to the floor/icu until a post-anesth assessment is filled out, so they call us when the pt is awake and ready to go.

 

[urge]

The OR should start late, at 9 or 10am, so that we may post op the overnight patients. Otherwise you will never see them.

 

[pd4emergence]

PP. I work at a few ASC's and a hospital. At the hospital, pacu calls us, we have a check box form and we fill it out. I pretty much do the same at one of our ASC's because it is affiliated with the hospital. The other ones we don't. Recently we have started filling one out on everybody at our ASC. They (the 2nd rate asc administrators) have decided that because we do it for cms pt's we need to do it for everybody. This wouldn't be too bad if I only did 10 or fifteen cases but the other day I signed about 20 pts (there were a fair number that I just missed, we probably did fifty endos that day). It all makes me want to go into academics.