I would like to know if there is a recommendation or standard that address the need for a PACU RN to accompany a patient to the unit who either has OSA or an epidural in place?

thank you
Sheila

The 2009 OPANA standards will have a specific protocol on the care of patients with diagnosed or suspected OSA (most pts are undiagnosed). Regarding discharge, these patients generally required a longer period of Phase I monitoring (2-4 hrs, depending on health care facility, extent & type of surgery, opioids used, severity of OSA, anesthesia used).

Transfer of these patients should follow established protocols. ie. ready for transfer when d/c criteria achieved (i.e. 9/10 Aldrete score). If the patient remains at risk for complications
(cardiac arrhythmias, desaturation) a nurse would accomany the patient of course, and the patient be transferred to an appropriate level of care (ICU or step down unit).

Regarding epidurals, these patients are at less risk of oversedation and respiratory depression; they recieve much smaller dosing of opioids related to the direct neuraxial route of delivery. The health care facility should have established protocols on d/c of the patient following spinal and epidural anesthesia. The bromage score ideally should be 0. Transfer need not be with an RN if the pt meets d/c criteria, the patient is stable, comfortable with return of motor control, regression of sensory block as per facility, and no hypotension with elevation of the head of the patients bed/stretcher.

Heather
OPANA

This would depend on the institutions you work at, established protocols there, and patient population served. At our facility having OSA or epidural analgesia is not reason alone for an RN to accompany the patient. If the patient were unstable requiring cardiac or other contiuous monitoring however, the patient would be accompanied on transfer with an RN

Heather