I usually try to set myself and our RN up for success in the pre op area by emphasizing our goal is TOLERABLE levels of pain control in recovery, letting them know they will have pain after surgery. Chronic pain? I ask for a baseline pain score number and relay that to the PACU RN and tell the patient that number is generally what we shoot for in PACU as a best case scenario.
I go the" it was a pleasure taking care of you" route. If they are in pain or nauseated, AKA leaving on a bad note, I usually say "your pain looks bad," turn to the RN purposefully and obviously: "RN, do you have everything you need? Can I write any extra orders for you?" then back to the patient *Hang in there, *insert patients first name*, we're working on it, just bear with us while we better address your pain/nausea and find something that works."
If they are crazy I will pull RN aside and ask them if they need anything special (Benadryl, haldol, small doses of versed) or we just agree to move the patient out quick.
If they keep saying 11/10 pain and RN says they refuse to transfer the patient with that pain score, I get very direct with the patient and I say: "our PACU will not let you leave this place until you tell her your score is 7/10. Consider this if you ever want to get IV push dilaudid in your own comfortable private room with family members, food and drink service, and a TV, and your cell phone again."
