a)
Provision and use of Phase 1 Postanesthesia Care Unit (Phase 1 PACU)
1) For the purposes of this Section, Phase 1
of postanesthesia care is the phase immediately following surgery, usually in a
recovery room, after which the patient is returned to his or her
room.
2) Postanesthesia care units
shall be provided by all hospitals in which surgery is performed. They shall be
in a separate room where patients who have undergone surgical procedures can be
immediately observed and receive specialized care by selected and trained
personnel and where, when necessary, prompt emergency care can be
initiated.
3) The services of the
Phase 1 PACU may be used for postpartum care if the delivery room or place of
delivery is in proximity to the Phase 1 PACU. Only clean (non-infected or
non-infectious) postpartum patients may be admitted to the Phase 1 PACU and
may, after appropriate observation, be returned to the maternity
department.
b) Personnel
1) Physician
A physician shall be responsible for the conduct of the Phase
1 PACU, for the training of Phase 1 PACU personnel, and for the establishment
of admission, discharge, and emergency policies and procedures.
2) Nurse
A) A registered nurse who has education and
experience in Phase 1 postanesthesia care shall supervise all personnel
performing nursing service functions.
B) A registered nurse shall be in attendance
at all times when patients are in the Phase 1 PACU.
C) There shall be sufficient nursing
personnel to provide the specialized care required for the postsurgical
patient. It is recommended that a ratio of one nursing personnel to two
patients be maintained at all times.
D) Nursing personnel shall be assigned
permanently to the Phase 1 PACU when patients are present.
c) Practices for operation of the
Phase 1 PACU
1) Only clean surgical cases
shall be admitted to the Phase 1 PACU.
2) Contaminated cases shall be returned to
the isolation room or a private room. Contaminated cases may be admitted to the
Phase 1 PACU when a separate isolation facility is within or adjacent to the
Phase 1 PACU.
3) A member of the
medical staff shall provide initial orders for the care of each patient upon
admission.
4) A member of the
medical staff shall be responsible for the patient's discharge from the Phase 1
PACU.
5) Anesthetized patients
shall be constantly attended. Side rails shall be attached to movable carts and
beds and raised above mattress level when occupied by anesthetized patients.
Cribs shall be provided for the anesthetized or postsurgical child.
6) Written policies and procedures, which
shall be reviewed regularly and revised as necessary, shall be
established.
7) A complete
orientation program and continuing in-service education program shall be
provided for all personnel assigned to the Phase 1 PACU.
8) Personnel with communicable diseases shall
be excluded from the Phase 1 PACU.
9) Visitors shall be permitted in the Phase 1
PACU if a hospital has adopted a policy, approved through the Governing Board,
that allows for visitation in the Phase 1 PACU while the patient is recovering
from a surgical procedure. Before allowing individuals to be present in the
Phase 1 PACU, the hospital shall have a policy in place that includes at least
the following:
A) Written consent of an adult
patient; the parent, guardian, or legal representative of a minor or a mentally
disabled adult; or the physician performing the surgery;
B) Notation in the patient's medical record
of the presence of additional visitors in the Phase 1 PACU during recovery of
the patient from a surgical procedure;
C) Application of safeguards against the
introduction of infection or other hazards by the visitor, including
orientation, education and training of the person, preferably prior to the
performance of the procedure but at least prior to visitation; this shall
include, at minimum, specifics regarding recovery, what can be expected, and
basic infection control practices expected of the visitor;
D) Provision of at least one additional staff
person in the Phase 1 PACU assigned to oversee, supervise and assist the
visitors for the period of time the visitors are present;
E) Provision of safeguards to ensure the
privacy of other patients who may be recovering from surgical procedures, which
may include separate rooms or some other type of separation for recovery of
patients who would have a visitor present. Privacy safeguards shall allow Phase
1 PACU staff to provide constant attention to anesthetized patients;
and
F) If, at any point during the
recovery of the patient, Phase 1 PACU personnel determine that the visitor
poses a threat to the safe, therapeutic recovery of the patient, personnel may
require the visitor to leave the Phase 1 PACU.
d) Drugs, supplies and equipment
Drugs, supplies and equipment shall be immediately and
continually accessible in the Phase 1 PACU, including emergencies. These shall
include cardiac-respiratory monitoring and resuscitation materials.
e) The Phase 1 PACU shall contain
and provide for a drug distribution station, including a secure area, adequate
hand-washing facilities, charting and dictating area, soiled utility area with
bedpan flushing device, and adequate storage space for supplies and
equipment.