The recovery room
All too often the recovery room has received
too little attention and is often inadequate in terms of size and equipment.
With increasing medicolegal considerations it is now imperative that each
theatre suite has a fully equipped adequate recovery room in which patients
recuperate to a stable level with regard to their cardiorespiratory system
before transfer back to the ward. The recovery room should meet the following
criteria:
the temperature should be between 19 and 220C, and the bed
linen should be warmed;
lighting should be adequate;
fire doors should be free;
piped oxygen should be available with a range of masks in appropriate
sizes;
suction apparatus should be attached to the wall, regularly checked and
appropriate tubing and sucker attachments available;
there should be no trailing tubes or wires;
adequate monitoring equipment is essential.
Monitoring
equipment should be available for every patient in the recovery room, screens
and curtains are appropriate for those spending a longer time in the recovery
room, and defibrillation equipment should be immediately accessible.
Management of the patient in recovery includes attention to the following:
the airway, with monitoring of the oxygen saturation;
pulse rate, blood pressure and respiratory rate which should be regularly
recorded on charts. The patient should be easily accessible on a trolley which
has brakes, safety rails and head-lowering facilities;
pain relief is mandatory and if the patient is having a
patient-controlled analgesic set up then adequate intravenous analgesics to
overcome initial pain is important;
pressure areas should not be overlooked;
hand hygiene of the staff between patients is important;
an emergency bell available to each bay should be clearly marked and in
good working order;
stands attachable to trolleys for intravenous infusions should be at hand
and fit well;
with regard to drug administration, this should be recorded on the
patients chart with both time and dosage and, of course, the controlled drugs
register should be kept up to date and double signed;
where a central venous pressure line is present, and particularly if
there are multiple channels, these should be handled in a strict aseptic way and
clearly labelled.
Before
the patient leaves the recovery room a clear record of the readings should have
been made and the line should be well secured. Additional observations should
include:
drains;
the presence of a stoma;
urine output;
nasogastric aspiration in terms of both quality and quantity. The
position of a drainage bag is checked (a leakage is all too common, stains the
pillow and leads to the patient developing a sore rash on his or her cheek);
chest (under water seal) drains should be monitored and be placed below
the level of the chest.