PRACTICE CORNER
Practice Corner Theresa Clifford, MSN, RN, CPAN
IN THIS EDITION of the Practice Corner, the clinical practice questions were chosen due to their direct relationship to the ASPAN 2008-2010 Standards of Perianesthesia Nursing Practice.1 Question: What is the difference between Phase I and Phase II? Response: Although the scope of perianesthesia nursing is changing, and the environment in which perianesthesia care is delivered varies widely, the actual role of the perianesthesia nurse in the various phases of care remains similar. Phase I describes the level of care provided when a patient is emerging from surgical, diagnostic, or interventional procedures requiring the administration of general or regional anesthesia or moderate sedation. The primary goals of nursing care during Phase I include the establishment and maintenance of a stable airway, hemodynamic stability to include blood pressure and heart rate, fluid resuscitation, pain management, nausea and vomiting management, normothermia management, and assessment for wound integrity and bleeding. ‘‘Constant vigilance is required during this phase.’’1 Phase II describes the level of care provided when the patient is being prepared for discharge to home or an extended observation environment. In this phase, the patient has a stable airway with good ventilatory status on room air (unless baseline status required supplemental oxygen at home), satisfactory pain management (as defined by the patient), satisfactory control of postoperative nausea and vomiting, appropriate ambulatory ability for procedure and baseline, etc. Question: How long does Phase I last?
Theresa Clifford, MSN, RN, CPAN, is ASPAN President 2009-2010. Address correspondence to Terry Clifford, PACU, Mercy Hospital, 144 State Street, Portland, ME 04101; e-mail address:
[email protected] .com. Journal of PeriAnesthesia Nursing, Vol 24, No 6 (December), 2009: pp 409-410
Response: This is another common question that presumes patients will move through each level of care in a consistent, predictable manner. Determining when the patient is ready to move from one phase of perianesthesia care to the next should NOT be decided by the clock. Each individual patient will demonstrate a wide variety of reactions and responses to the administration of anesthesia. Each individual patient will demonstrate a wide variety of reactions and responses to the surgical/procedural experience as well. In addition to the individuality of patients, there are a number of factors that impact the overall readiness-to-move. These may include variables such as practitioner preference in anesthetic choices, the use of preoperative anxiolytics, history of prolonged emergence, and the presence of preexisting medical conditions. The decision to move a patient from one level of care to the next should be based on clinical assessments and desired patient outcomes and criteria. The ASPAN Standards provide comprehensive lists of assessment criteria that can be used for discharge from Phase I and Phase II (found in Resource 3).2 According to the American Society of Anesthesiologists Standards for Postanesthesia Care, Standard V, when discharge criteria are used in a perianesthesia care environment, they should be approved by the Department of Anesthesiology.3 These discharge criteria may vary depending on the disposition and condition of the patient. Ultimately, the patient will need to meet the institutional criteria for discharge from either Phase I or Phase II as appropriate. This column provides readers with an opportunity to submit perianesthesia practice questions. What is your practice concern? Are you interested in exploring ways to enhance your practice and explore perianesthesia resources? Send your question to practicecorner@ aspan.org.
Ó 2009 by American Society of PeriAnesthesia Nurses 1089-9472/09/2406-00012$36.00/0 doi:10.1016/j.jopan.2009.10.006
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References 1. American Society of PeriAnesthesia Nurses. 2008-2010 Standards of Perianesthesia Nursing Practice. Cherry Hill, NJ: ASPAN; 2008:5. 2. American Society of PeriAnesthesia Nurses. 2008-2010 Standards of Perianesthesia Nursing Practice. Cherry Hill, NJ: ASPAN; 2008:62-67.
3. American Society of Anesthesiologists. Committee: Standards and Practice Parameters. Standards for postanesthesia care. 2004. Available at: http://www.asahq.org/publicationsAndServices/standards/36.pdf. Accessed August 29, 2009.