1. Describe the type of service you provide in your Anaesthetic/Recovery Room.
The Elective Orthopaedic Centre (EOC) is a purpose-built orthopaedic hospital providing predominantly hip and knee replacements to a population base of 1.5 million people in South West London.
The centre currently provides 65 beds including a 15-bed Post Anaesthetic Care Unit (PACU) and has 4 state-of-the-art orthopaedic operating theatres. PACU has both recovery and critical care facilities with an average of 16 patients a day. Length of stay depends on the patient’s co-morbidities and surgical procedure. Our PACU also provides resuscitation and outreach services.
2. How is your unit set up?
Our PACU was set up to respond to the demand for critical care facilities following elective orthopaedic surgery. We currently have 15 beds and are expanding to 17 within the unit. PACU is unique in that the patient stays where they are and the team move equipment to the bed as required. For example, if circumstances require a change from recovery to intensive care, equipment specific to the step up in clinical demand is brought to the patient, rather than move the patient to a different department. This is possible because of the flexible gantry systems we deploy in PACU. The advantages are that no time is lost in physically transferring the patient and focus is maintained because there are no handover issues ensuring a much higher standard of care. This approach allows us to care for both recovery and critical care patients in the same department, promoting continuity of care and offering excellent developmental experiences in both recovery and critical care. Our PACU is open 24 hours a day, 7 days a week to provide recovery and critical care services.
3. Introduce us to your team.
I have a total of 28 staff. I lead in PACU and employ 8 Advanced Practitioners, 3 Senior Qualified Practitioners, 13 Qualified Practitioners, 1 Health Care Assistant, 1 Ward Clerk and our Domestic, Bruce. We have Advanced Practitioners and Qualified Practitioners instead of Sisters and Staff Nurses. They are a fantastic team who are very flexible and often change their rota to meet the needs of the service. This allows us to stay within budget and the option to draft in extra staff when necessary.
We have Advanced Practitioners on every shift with 5 to 7 staff depending on patient dependency. The practitioners are trained in extended roles such as venepuncture, nurse prescribing, physical assessment and cannulation. This higher level of education allows the staff to take on some of the roles of the junior doctor. We work closely with the EOC multidisciplinary team, which includes 24 hour care from the onsite Intensivists, Physiotherapists, Pharmacy and X-ray.
4. What are the daily clinical or managerial challenges you cope with in your unit?
I have an open door policy, which does not always mean I leave on time! When I manage to escape from the office I really enjoy being on the ward with my team looking after patients. As Lead Practitioner I have responsibilities as a clinical lead, educator and manager. No 2 days are the same and as a result working in PACU is both challenging and rewarding. I have the usual tasks of ensuring we have enough staff and beds whilst remaining within budget but I like to think that my staff can call on me at any time. Our centre is relatively new and we are fortunate to have the latest equipment and facilities.
No matter what the day may bring our patients and staff come first. My roots are in nursing and I enjoy being on the shop floor helping out where I can. Teamwork is our core value. It is an easy thing to agree to but takes time to establish and maintain. It is the key to the way our successful department runs
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5. What part of your working day do you find the most rewarding?
Being with the patients and part of the team. Although I have days when the paperwork never seems to stop, walking out of my office and seeing the staff and patients reminds me why I am here. Having the office door open I hear the banter and laughter. PACU is an integral part of the patient’s experience and we try to make their time with us as enjoyable and relaxed as possible. We also encourage open visiting within PACU to provide extra reassurance.
6. How do you orientate learners to your unit and what provision do you have for ongoing education?
At the EOC we have an education team dedicated to developing and supporting staff. Staff are allocated a ‘buddy’ and mentor and have a 2-week formal induction programme. During induction, staff follow the patients pathway from pre-assessment to theatre, PACU and the wards. Following orientation to the pathway, new starters experience a period of 4 weeks where they are supernummery allowing time for learning and ensuring my existing team are not over-stretched. This 6-week programme ensures high-quality care for our patients.
We have competencies and in-house teaching courses to enable staff to obtain extended roles such as venepuncture and cannulation and different development programmes. We also run the ALERT course. Investing in our staff is a vital component at the EOC. We encourage staff to attend both national and international study days and CPD courses. In return we ask staff to share their knowledge and skills through mentorship. PACU have held national study days and hope to provide more in the future to help raise the profile of PACU nursing.
7. What was the last audit/research your unit took part in, and what were the outcomes?
At the EOC we have a dedicated research department. PACU has participated in national drug trials to assist in the development of new oral anticoagulants to reduce the risk of venous thrombo embolism with the research team. At present PACU is participating and leading on the National Comparative Audit for Blood Transfusion looking at bedside transfusions within our centre.
