Hey guys, I'm new to the forum so please be gentle. Just started my CA-1 year and have received a lot of different opinions to sign out to PACU nurses. During my first few days I would give a thorough signout i.e PMH, Meds at Home, Induction, airway, intraop, problems, etc. Some nurses start rolling their eyes as if I'm giving too much info. So I start abbreviating and now the complain I give crappy sign outs. Is there a certain checklist you guys use? May sound trivial, but just wanted to hear what other had to say.
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Started by gasrookie
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Dude, they are nurses just give them what they need. If they don't like it usually its b/c they don't get it. They are not going to understand everything you checkout to them if you are too in depth. I'm not bashing the nurses. They were probably rolling their eyes b/c they didn't know what to do with all the info. Really, all they want is the information that fills in the blanks on their forms, IV fluids, EBL, UOP, narc's and antibiotics. It always kills me when I hear the OR circulator tell the pacu rn that 30cc of local was injected in the incision. Who flippin cares, they are either in pain or they aren't.
Tell them...
The procedure.
BRIEF PMH that might effect them in PACU - fibromyalgia, MVP, bunions, are not terribly germane.
Home meds - BP, cardiac, lung, DM and perhaps their antidepressant meds are the biggies - not the laundry list, and not necessarily specific drugs.
Induction and airway - is there anything THEY need to know? If you didn't have problems, there's nothing to say.
Intraop - is there anything they need to know? If you didn't have problems, there's nothing to say.
Drugs - they don't need to know that they got sux for intubation, roc for relaxation, des/sevo/iso for maintenance, reversal drugs, etc. Narcs, vasoactive or cardioactive drugs, etc. obviously fine.
Fluids, blood, urine output, EBL- all nice to know.
Get a set of vitals while giving the report, and you're done.
Most other stuff I assume they're capable of reading the record and pre-op sheet if they really want more specifics.
For example -
This is Mr Smith - we did a Lap chole. He has a history of hypertension and is an oral diabetic, both well controlled on meds. He got 2cc of fentanyl at the start, 10 of morphine and some zofran at the end. There were no problems during the case. This is his 2nd bag of IV fluid, EBL <50cc, and no foley so no urine. Happy? OK, see you again shortly. Buh-bye.
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"This is Mrs. So-and-so. Surgeon X did a lap chole"
Relevant medical issues, like her pulse was 45 before induction, or her pressure lives in the 160s, needed a neo drip but off now, whatever. Also diabetes, and maybe a relevant pre-op sugar (I've found nurses LOVE fingerstick glucose- easy algorithm to understand and treat)
Drug allergies
Tube v. LMA, # narcs, whether they were paralyzed/reversed
IV fluid, EBL, blood loss.
Relevant medical issues, like her pulse was 45 before induction, or her pressure lives in the 160s, needed a neo drip but off now, whatever. Also diabetes, and maybe a relevant pre-op sugar (I've found nurses LOVE fingerstick glucose- easy algorithm to understand and treat)
Drug allergies
Tube v. LMA, # narcs, whether they were paralyzed/reversed
IV fluid, EBL, blood loss.
As quickly as possible:
Pts name - age - allergies and weight
Surgery and reason for sugery along with any important PMH that may affect their post-op course (HTN, A fib, CHF, ect)
Antibiotics and time
Meds given (only benzos, narcs, whether they were paralyzed and reversed and anti-emetics)
If they were stable intra-op or not (and if not, why) or if they were an easy or difficult intubation
Fluids, EBL and urine output
What kinds of lines they have, if they have a foley
And then ask if they have any questions.
They really should be able to look at the green sheet to find out any info I might have missed
Pts name - age - allergies and weight
Surgery and reason for sugery along with any important PMH that may affect their post-op course (HTN, A fib, CHF, ect)
Antibiotics and time
Meds given (only benzos, narcs, whether they were paralyzed and reversed and anti-emetics)
If they were stable intra-op or not (and if not, why) or if they were an easy or difficult intubation
Fluids, EBL and urine output
What kinds of lines they have, if they have a foley
And then ask if they have any questions.
They really should be able to look at the green sheet to find out any info I might have missed
I save a few syllables on the oral report - and how you record your drugs isn't necessarily as important as them actually being recorded. I think most would understand that Fentanyl 2cc=100mcg. And some drugs are recorded by volume - EnlonPlus is a personal favorite.
There is a PACU form the nurses fill out as we give them report. Even though it's a nurse's form to fill out, well-intentioned anesthesiologist residents started filling in some of the info the help out the nurses. It was probably much appreciated at the the beginning but now, if I don't hand the nurse a filled out form when I arrive in the PACU, I get the 
look followed by the 
and a 
don't do it again. I'm happy to help out and all but expecting me to do their paperwork when I'm still learning my own is frustrating. I told one of my attendings and he used a lot of swear words but basically said to tell them to do their own paperwork for now on. So, what was initially an effort to help out the nurses has now become an expectation on their part. Whatever.
look followed by the and a don't do it again. I'm happy to help out and all but expecting me to do their paperwork when I'm still learning my own is frustrating. I told one of my attendings and he used a lot of swear words but basically said to tell them to do their own paperwork for now on. So, what was initially an effort to help out the nurses has now become an expectation on their part. Whatever.
There is a PACU form the nurses fill out as we give them report. Even though it's a nurse's form to fill out, well-intentioned anesthesiologist residents started filling in some of the info the help out the nurses. It was probably much appreciated at the the beginning but now, if I don't hand the nurse a filled out form when I arrive in the PACU, I get the
.... and you thought you would only have to go through Jack's Valley once in this lifetime, silly Zoomie.
.
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