PACU Skills Checklist

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Directions for Completing Skills Checklist


The following is a list of equipment and/or procedures performed in rendering care to patients. Please indicate the level of experience/proficiency with each and, where applicable, the types of equipment and/or systems with which you are familiar.

Use the following KEY as a guideline:
A) Theory Only/No Experience - Didactic instruction only, no hands-on experience.
B) Limited Experience - Knows procedure/has used equipment, but has done so infrequently or not within the last six months.
C) Moderate Experience - Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed.
D) Proficient/Competent - Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach.

CLINICAL PRACTICE

ABCD
Communicate with patients using age and cultural appropriate methods
Review medication history i.e. pre-operatively, intra-operatively, drug/alcohol use
Apply and maintain anti-embolic devices in PACU for DVT prophylaxis per doctor orders
Provide post-operative education, including discharge instructions to both patient and family
Determine patient's readiness for discharge from PACU, using facility specific criteria
Use Personal Protective Equipment (PPE) when indicated in the PACU environment
Anticipate needs of the patient and team members i.e.: equipment, supplies, fluids
Utilize assistive pulmonary support i.e.: bag valve mask and ventilator/bipap/cpap, adjustment of settings, extubation parameters, weaning protocols
Assess and maintain patent airway
Formulate nursing diagnoses based upon comprehensive assessment
Perform post-operative teaching for surgical patient/family
Perform hand off process from surgical services staff and to receiving unit to ensure continuity of care
Collaborate with interdisciplinary teams in the pre-operative, intraoperative, and post-operative environments
Perform universal protocol per facility policy
Perform frequent assessment of surgical sites, surgical dressings, drains, tubes
Manage factors in the PACU to facilitate adequate environment for the post-surgical patient i.e.: noise, traffic, temperature
Follow and use equipment according to manufacturer's recommendations, including testing/QA, cleaning
Transport specimens as indicated by organizational policy and procedure
Perform and maintain accurate patient records and documentation in the PACU setting
Implement effective solutions for communication with patient when barriers exist (e.g. physiological, cultural, language).
ABCD
Peripheral IV placement
Indwelling and/or straight urinary catheter
NG tube
Point of care testing
Suctioning
ABCD
Aldrete Scoring System
Modified Scoring System
White's Fast Tracking Scoring System
Post Anesthetic Discharge Scoring System (PADSS)
Braden Scale
Richmond Agitation Sedation Scale (RASS)
Glasgow Coma Scale (GCS)
Dermatome Levels

EQUIPMENT

ABCD
Cardiac monitor
Ventilator
IV Pump
Electric bed
PCA pump
Suction equipment
Oxygen saturation monitor
CPM machine
Defibrillator

INVASIVE PROCEDURES

ABCD
Nerve Blocks
Insertion of Chest Tubes
Central Lines
PICC Lines
Tracheotomy
Intubation
A-line Placement
Pulmonary Artery Catheter (Swan Ganz) Placement

COMMON SURGERY SUBSPECIALTIES:

ABCD
General surgery
Colon and rectal surgery
Endoscopic procedures
Ear, nose & throat
Gynecology and Obstetrics
Gynecologic Oncology
Neurology
Ophthalmology
Oral and maxillofacial
Orthopedics
Pediatrics
Plastics
Thoracic/Open Heart
Transplant
Trauma
Urology
Vascular

PHYSIOLOGIC BALANCE

ABCD
Review all pertinent patient data related to physiologic status i.e.: lab values, allergies, secondary diagnoses/conditions, NPO status
Perform complete physical assessment on surgical patient
Perform interventions specific for maintaining normal thermal stability
Perform interventions specific for maintaining physiological comfort i.e.: nausea, vomiting, positioning, pain
Identify patient's actual and potential physiological responses to operative experience i.e.: tissue perfusion, body temperature/thermal regulation, infection
Administer blood products as ordered by physician to maintain hemodynamic status

EMERGENCY SITUATIONS:

ABCD
Loss of airway
Cardiac Arrest
Respiratory Arrest
Malignant Hyperthermia
Anaphylaxis
Environmental disasters

PROFESSIONAL ISSUES

ABCD
Participate in root-cause-analysis of events i.e.: sentinel events, medication errors, near-misses
Participate in performance improvement initiatives, projects
Manage outside personnel when present in the PACU environment i.e.: supply/equipment vendors, students, family members
Delegate appropriate tasks to other personnel as necessary within scope of practice
Perform all nursing functions within the RN's scope of practice
Follow chain of command in regards to reporting potential situations i.e.: possible drug diversion/impairment, medication errors, sentinel events
Confirm patient identification, using a minimum of 2 patient identifiers
Confirm presence and status of DNR orders and/or advance directive
Develop, monitor, and revise plan of care for the PACU patient
Communicate with multiple members of the interdisciplinary team in the PACU regarding patient status i.e.: critical lab values, medications, allergies
Maintain privacy and dignity for each patient during entire PACU stay
Maintain patient confidentiality according to HIPAA guidelines, including status updates to family members
ABCD
Proper positioning and use of safety devices (padded side rails, restraints, safety straps)
Promote safety for patient, staff and visitors in the PACU setting i.e.: chemical exposure, exposure to radiation

SURGICAL SETTINGS

ABCD
Acute Care Hospital
Outpatient Surgery Center (also called Day Surgery, Same-Day Surgery, or Ambulatory Surgery)
Cosmetic and/or Facial Surgery Center
Endoscopy Center
Ophthalmology and/or Laser Eye Surgery Center
Oral and Maxillofacial Surgery Center
Orthopedic Surgery Center
Other Office-Based or Clinic-Based Surgery Center
Other Specialty Surgery Hospital or Center

Age Specific:

ABCD
Infant (Birth to 1 year)
Toddler (1-3 years)
Pre-school (3-6 years)
School Age (6-12 years)
Adolescent ( 12-18 years)
Young Adult ( 18-30 years)
Mature Adult (30-60 years)
Elderly (>60 years)
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