Our Perianesthesia Care Unit (PACU) provides efficient, safe care to over 100 surgery patients a day. Length of stay in PACU is approximately two hours and is dependent on many factors such as type and length of surgery. As hospital census and patient acuity increased, it was noted that several patients remained in the PACU, even overnight, after anesthesia signed off from their care. A process was needed to identify and manage patients who remained in the PACU after anesthesia discharge.

Transcutaneous measurement of carbon Dioxide (TrCO2) is a non-invasive method of estimating arterial pressure of carbon dioxide (PaCO2). Side-stream capnography is common in assessing ventilation but its ability to estimate hypoventilation is affected by patient factors. Measurement of oxygen saturation is a standard of care but is a poor indicator of early hypoventilation. Our Perianesthesia Care Unit (PACU) recovers over 100 surgeries daily. We wanted to assess the use of TrCO2's ability to provide early recognition and treatment of airway compromise to increase patient safety.

As healthcare faces demands to decrease length of stay and increase patient satisfaction, hospital staff seeks to streamline the discharge process. Evidence suggests an interdisciplinary discharge process results in increased nurse satisfaction, reduced incidence of medical errors and hospital acquired infections. The purpose of the Vascular Surgery and Transplant Unit (VSTU) Discharge by Eleven Project is to identify barriers to discharge and increase efficiency throughout the discharge process. A patient database was developed to detect variables affecting early discharge. An improvement plan was implemented focusing on timeliness of writing discharge orders by surgical residents and early recognition of potential discharge by nursing, medical and casemanagement staff. Subsequently, the ‘VSTUResidentSurvival Guide’was createdhighlighting the expectationsof nurses rounding daily with attending physicians and residents to identify discharges for the next day. Methods of communication included the team leaders, who served as discharge champions, and utilization of the assignment board as a visual cue.Nurseswere instructed to communicate that discharge occurs before eleven to every admission. Discharge times and customer satisfaction scores were posted weekly. The five month study showed an increase in the satisfaction with speed of the discharge process (75 to 89.3) and overall satisfaction with the process (83.6 to 89.3) based on Press Ganey raw scores. The percent of discharges by eleven increased from 11% to 15% and late discharges decreased from 50% to 37%. These findings suggest that by targeting unit specific variables early discharges can be increased.

Purpose: The perianesthesia care unit (PACU) recovers 80 to 100 patients a day. The volume of patients that require recovery also require an attending anesthesia provider to discharge the patient to an inpatient bed or to Phase 2. The working relationship with anesthesia and the PACU is intricate in promoting quality improvement and providing safe, efficient care.

Purpose: The Perianesthesia Care Unit (PACU) performs rapid recovery for 80 to 100 patients a day. Traditionally, patient care technicians in the recovery room are utilized for transporting patients to the divisions after they are released from anesthesia care. In between trips, the technicians are expected to assist at the bedside; i.e., drawing blood, emptying urine and drains, obtaining vital signs and EKGs. PACU leadership noticed minimal participation in technicians doing these bedside tasks. When questioned, the technicians voiced feelings of uncertainty regarding patient acuity and “shying away” from getting too close. To address educational issues, promote comfort in providing patient care, and improve participation at the bedside, an education program was developed.

Purpose: The PACU (perianesthesia care unit) is a fast-paced, highly technical, critical care area. To face daily challenges, we formed a committee to address issues and concerns and also formulate potential solutions.

Purpose: Reviewing the current PACU (perianesthesia care unit) orientation process, PACU preceptors reviewed the current binder, updated content, established a timeline to orient through different areas, and provided checklists to assess strength and weaknesses. Content was also provided on a flash drive to provide a more user friendly method.

Clofarabine has significant single-agent activity in patients with indolent and aggressive non-Hodgkin lymphoma and synergizes with DNA-damaging drugs. Treatment, however, may be associated with severe and prolonged myelosuppression. We conducted a phase 1 trial to determine the maximum tolerated dose (MTD) of clofarabine in combination with high-dose etoposide and cyclophosphamide followed by autologous peripheral blood stem cell transplantation in patients with refractory non-Hodgkin lymphoma (NHL). Patients received clofarabine at 30-70 mg/m(2)/day on days 6 to 2 in successive cohorts, in combination with etoposide 60 mg/kg (day 8), and cyclophosphamide 100 mg/kg (day 6), followed by filgrastim-mobilized PBSC on day 0. Sixteen patients of median age 57 (range: 32-67) years with diffuse large B cell (n = 8), follicular (n = 5), or mantle cell (n = 3) lymphoma that was either primary refractory (n = 2) or relapsed and refractory (n = 14) were treated at 5 clofarabine dose levels: 30 (n = 3), 40 (n = 3), 50 (n = 3), 60 (n = 3), and 70 mg/m(2)/day (n = 4) in combination with etoposide and cyclophosphamide. All patients had grade 4 neutropenia and thrombocytopenia. Grade 3-4 nonhematologic toxicity was evenly distributed across all 5 dose levels, and included diarrhea (n = 3), mucositis (n = 1), nausea (n = 1), reversible elevation of alanine aminotranferease/aspartate aminotransferase (AST/ALT) (n = I) or bilirubin (n = 1), and hemorrhagic cystitis (n = 1); all resolved by day +30 following transplantation. The MTD was not reached. No treatment-related deaths occurred. At day +30, 13 patients achieved a complete remission (CR) or unconfirmed CR (CRU), and 2 patients achieved a partial response, for an overall response rate of 94%. After a median follow-up of 691 days, the 1-year progression-free survival (PFS) and overall survival (OS) were 63% (95% confidence interval [CI]: 43%-91%) and 68% (95% CI: 49%-96%), respectively. We recommend clofarabine 70 mg/m(2)/day x 5 days as a phase 11 dose in combination with high-dose etoposide and cyclophosphamide for further testing as a preparative regimen in NHL patients undergoing autologous PBSC transplantation. Biol Blood Marrow Transplant 17: 987-994 (2011) (C) 2011 American Society for Blood and Marrow Transplantation

Purpose: The Perianesthesia Care Unit (PACU) performs rapid recovery for 60 to 100 patients a day. The PACU has over ninety bays and staffs with 55 nurses to provide safe, quality care. The importance of developing staff potential was a primary goal. The Clinical nurse manager and clinical nurse specialist for the PACU collaborated to put into place a program to provide opportunity for staff to participate and develop in their roles.

Purpose: The perianesthesia care unit (PACU) has many staff that go above and beyond the standard care staff provide. The hospital has reward and recognition programs for employees. The PACU did not have any reward and recognition process. It was decided to implement a unit specific award to recognize staff.

Purpose: Our hospital was preparing to begin performing intra-operative MRI pediatric surgery in conjunction with the system's pediatric hospital. Preparation was needed in the PACU to provide care pre-operatively and post-operatively with collaboration of nurses from both hospitals.

Purpose: The Perianesthesia Care Unit (PACU) performs rapid recovery for 60 to 100 patients a day. Due to the volume of patients, tracking outcomes and clinical events is important for allocation of staff. A tool was already in place to capture patient total time in recovery. This tool was revised to include a place to document post-operative clinical indicators, eliminating the need for an additional form. The PACU staff nurses use this form on each patient to identify any post-operative clinical events.

Purpose: In order to assess patient satisfaction regarding post-operative care, our PACU (perianesthesia care unit) developed an audit tool to use when rounding on the divisions while checking on patient's first day post-operative follow-up visit.

Purpose: Documentation is a key element in the nursing process. In order to tell how well we are doing, we regularly audit the charting and forms used by the PACU nursing staff.