This is the final episode of this series on general anesthesia! PACU handover can seem complicated, but it's ultimately about transferring professional and care responsibility for your patient after surgery. For this week's episode, remember the acronym "ISBAR" - as always, check out our step-by-step approach below:
- ID + Introduction: introduce yourself, the surgery team and your patient. This is who YOU are.
- Situation: identify the type of surgery, whether it was elective/urgent, and under what modality of anesthesia your patient just came from (e.g. "John Doe just underwent an elective laparoscopic appendectomy under general anesthesia)
- Background: state your patient's pertinentmedical history and their risks for anxiety, PONV, changes in baseline cognitive status, etc.
- Anesthesia/Actions: mention the technique of anesthesia used and share the patient's airway features, and if there were any difficulties during the case. This helps the PACU team anticipate problems EARLY! (e.g. "He was difficult to intubate and experienced potential bronchospasm intraoperatively lasting 10 minutes"). Also state the drugs used and their quantities (e.g. "He was given 2mg midazolam, 150mg propofol, 70mcg fentanyl and 10mg ondansetron). Finally, quantify fluids in/out, any pressors/blood products used and their ongoing needs.
- Recommendations: use the PACU order sets to describe what you'd like for your patient (e.g. pain control, PONV medications, IV fluid replacement, hemodynamic management, discharge planning info and when to call the MD for help). (e.g. "We've completed the PACU order set and John is expected to return home today. Any questions?"
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