Stanford PACU Rotation Educational Site
LEARNING OBJECTIVES AND CLINICAL RESPONSIBILITIES FOR THE ANESTHESIA PACU ROTATION
Updated September 2021
- Learning Objectives:
- Understand the evaluation and management of common immediate postanesthesia conditions and complications including:
- Airway management
- Acute postoperative pain
- Nausea and vomiting
- Hypothermia
- Hypotension
- Hemorrhage
- Altered mental status
- Cardiac dysrhythmias
- Understand, recognize and treat rare postanesthesia conditions such as MI, CVA etc.
- Understand and be able to recognize how a patient’s medical and surgical diseases play a role in their PACU course and what are typical PACU concerns.
- Be able to formulate and execute a treatment plan for any PACU issues and know who to involve in the care and management of PACU patients.
- Identify the appropriate standard and advanced monitors to have the most optimal PACU patient care.
- Understand key issues regarding postoperative pain management through a variety of techniques including patient controlled IV opiate infusions (PCA´s), epidural infusions, and peripheral neural blockade.
- Understand relevant discharge criteria.
- Understand normal response to surgery and anesthesia and how this affects outpatients, i.e., what patients can expect in the days to weeks following surgery.
- Be able to assess a patient's readiness for discharge to home v.s. discharge to the inpatient floor v.s. discharge to the ICU.
- Be able to recognize and manage PACU crisis situations.
- Review the medical literature relating to postoperative management which will be included in the rotation materials.
- Attend specific educational conferences which will be held weekly.
- Be able to communicate effectively with patients and all relevant members of the care team (nurses, primary anesthetic team, specialty consults, ICU team etc.)
- Optional learning objectives include using point-of-care ultrasound, TTE and topics of special interest to the resident.
- Understand the evaluation and management of common immediate postanesthesia conditions and complications including:
- PACU Resident Responsibilities:
- The PACU resident will remain in the main OR PACU beginning at 8:00 and until 6:00 pm unless urgent clinical needs require them to be elsewhere, or they are attending educational conferences. The resident will receive a 30-minute lunch break as well as 15- minute morning and afternoon breaks as clinical duties permit.
- The resident will utilize the morning prior to the arrival of PACU patients for reading. The expectation is to review at least one paper per day.
- The resident should evaluate all university service postoperative patients (i.e., not Palo Alto Clinic or AA cases) upon arrival to the PACU. The resident should be present for a report from the primary anesthesia team. The resident will help manage the patients while they remain in the PACU. Management issues may include but are not limited to: reviewing chest x-rays for line placement, adjusting pain, antiemetic orders, fluid therapy, as well as ordering and reviewing diagnostic tests as appropriate. The resident should remain in close communication with the primary anesthesia team should unexpected developments occur with a patient while in the PACU. The PACU resident is responsible for signing those PACU patients they follow on the PACU nursing assessment form. The attending anesthesiologist will be responsible for signing the patients out during those times the PACU resident is not present (after 5 p.m.). The attending anesthesiologist will continue to write the post-anesthesia note in the Progress Note Section.
- The attending anesthesiologist from the primary anesthesia team will serve as PACU residents´ immediate backup. If they are not readily available the secondary backup will be the attending anesthesiologist who is scheduler for that day (x60249).
- The resident will be responsible for any postoperative pain procedures that are placed in the PACU such as epidurals and peripheral nerve blocks.
- The resident will place the initial epidural orders for patients coming out of the OR. They will need to inform the Pain service about these patients. The Pain service will follow these patients on the wards.
- The resident is expected to attend the Weekly the Afternoon Resident Lecture Series and Monday Morning Grand Rounds.
- PACU Resident Assignments:
- The PACU resident is expected to review the teaching modules made available to them and to review the test questions associated with each presentation.
- The PACU resident will give a 10-minute in-service talk to the PACU nurses on a subject matter of their choice.
- Keep a log of all procedures performed or problems dealt with (i.e. arterial line, intubations, femoral nerve blocks, epidural) and complete the self assessment form.
- Review a minimum of one journal article per day.
- The resident is expected to complete the pre and post PACU test questions.
