October 21, 2013 | Health System Risk Management
Patient safety risks abound in postanesthesia care. Especially during phase I care, patients are typically in a physiologically vulnerable state and require close monitoring of their basic life-sustaining body systems. (See Phases of Postanesthesia Care for an overview of the three phases of postanesthesia care. ) They may be unconscious or semiconscious and thus unable to fully participate in their care, answer questions, or advocate for themselves. Even when conscious, they are recovering from both the anesthesia and the procedure. Patients often receive or are being monitored for the effects of high-alert medications, heightening the potential for harm in the event of adverse drug reactions or medication errors.
Data on complication rates illustrates this vulnerability. In a 2006 prospective study of 1,000 randomly selected patients at one acute care hospital, the rate of anesthesia-related complications was 23% in phase I PACU care, compared with 4% in the OR. Of all complications occurring during phase I PACU care, the most common were need for upper airway support to maintain a patent airway (40%), nausea and vomiting (31%), tachycardia (13%), hypertension (11%), and hypotension (7%). The author concluded that the results “reinforce that the PACU is a critical care setting.” (Tarrac)
Inherent operational factors can pose further challenges to optimal postanesthesia care. The high volume and fast turnover of patients may mean a high potential for wrong-patient errors, constant handoffs to and from the setting, other challenges to communication and care coordination, and pressure to “keep patients moving,” to name a few risks. Many postanesthesia settings care for a patient population that is diverse in terms of preprocedure health status, age, procedures undergone, and continuing health needs.
The American Society of PeriAnesthesia Nurses (ASPAN) has identified specific safety issues that require attention. Those that are pertinent to postanesthesia care relate to the following (Krenzischek et al.):
Strategies for addressing many of these patient safety issues are discussed...