The Post-Anaesthesia Care Unit

Principles of PACU:

A PACU is required for all patients who have recently undergone surgery or other procedures, irrespective of the type of anaesthesia or sedation used
Patient safety is paramount
- If patients are transferred to PACU from elsewhere, they must be monitored as per guidelines for transport of the critically ill patient.
Recovery staff should be trained for their role, have appropriate supervision, and have appropriate paediatric experience (if required)
With respect to nursing ratios:
- All patients must be monitored one-to-one until the patient:
  - Controls their own airway
  - Has stable observations within acceptable limits
  - Can communicate purposefully
  - Is awake
- Two-to-one ratio is usually needed during reception
  - Second person may be the anaesthetist or operating room nurse
With respect to airway devices:
- Intubated patients must be monitored by the anaesthetist
- Patients with a SAD must be breathing spontaneously
- The anaesthetist cannot leave a facility whilst a SAD is still in situ for their patient
Must be resourced to:
- Manage common and expected outcomes of the given procedure
- Cover the spectrum of patients managed in that facility
- Manage airway, respiratory, and cardiovascular complications
- Treat both common and life-threatening post-anaesthetic events
  e.g. PONV, pain, anaphylaxis.
Must have an emergency call system to summon assistance from appropriate areas within the facility

Design Features

Part of the operating theatre or procedural suite
Have easy access from the operating theatres
Accessible without passing through OR
Have routes for rapid evacuation if required
Have enough bed spaces to accommodate expected peak loads
Adequate space for the patients bed, equipment, and personnel:
- A minimum of 9m² for each patient
- Up to 20m² for higher-acuity patients
Staff should be able to view all patients at once
‘Line-of-sight nursing care’.
Separate area for paediatric patients, if the facility deals with both adult and paediatric patients
Each bed space must have:
- An oxygen outlet
- Medical suction
- At least four power outlets
- Appropriate lighting and wall colour to allow accurate assessment of skin colour
- Emergency lighting
- Facilities for mounting equipment
- Facilities for charting/accessing electronic records
A clock
Emergency power supply
Access for portable x-ray

Within all PACU there must be:

Equipment for manual ventilation:
- At least one per two bed-spaces
- Not less than two
Equipment and drugs for intubation
Capnography
ECG monitoring
Nebulisers
Drugs
Including:
- Emergency drugs
- Antiemetics
- Analgesics
- Local anaesthetics
Intravenous fluids
Thermometer
BSL and ketone testing
Stethoscope
Defibrillator
Handwashing basin
Routine for checking equipment

For facilities conducting general anaesthesia, major regional/neuraxial anaesthesia, or major surgery, there should be easy access to:

Each bed space must have:

Each bed should:

Have a firm base and mattress allowing effective CPR
Tilt both head-up and head-down at least 15°
Be easy to move
Have efficient and accessible brakes
Have secure side rails which must be able to be dropped below the base or be easily removed
Have provision for maintaining IV infusions

Patients should remain until they are: