Published: 12/08/2019

Postoperative and recovery room care

Learning outcomes:

  • To manage the recovery of patients from general anaesthesia
  • To describe the organisation and requirements of a safe recovery room
  • To identify and manage common postoperative complications in patients with a variety of co-morbidities
  • To manage postoperative pain and nausea and vomiting
  • To manage postoperative fluid therapy
  • Safely manage emergence from anaesthesia and extubation
  • Shows awareness of common immediate postoperative complications and how to manage them
  • Prescribes appropriate postoperative fluid and analgesic regimes
  • Assess and treats PONV

Knowledge
Competence Description Assessment Methods GMP
PO_BK_01 Lists the equipment required in the recovery unit A,C,E 1
PO_BK_02 Lists the types of monitoring and the appropriate frequency of observations required for patients having undergone different types of surgery A,C,E 1
PO_BK_03 Describes the care of an unconscious patient in the recovery room, including safe positioning A,C,D,E 1,2
PO_BK_04

In respect of restoring spontaneous respiration and maintaining the airway at the end of surgery:

  • Explains how to remove the tracheal tube and describes the associated problems and complications
  • Recalls/describes how to manage laryngospasm at extubation
  • Recalls/lists the reasons why the patient may not breathe adequately at the end of surgery
  • Recalls/identifies how to distinguish between the possible causes of apnoea
  • Lists the possible causes of postoperative cyanosis
  • Describes how to evaluate neuro-muscular block with the nerve stimulator
 A,C,E 1
PO_BK_05

With respect to oxygen therapy:

  • Lists its indications
  • Lists the techniques for oxygen therapy and describes the performance characteristics of available devices
  • Recalls/explains the causes and management of stridor
 A,C,E 1,2
PO_BK_06 Outlines/recalls the principles of appropriate postoperative fluid regimes including volumes, types of fluids and monitoring of fluid balance including indications for urethral catheterisation A,C,E 1
PO_BK_07

In respect of postoperative pain:

  • Describes how to assess the severity of acute pain
  • Describes the ‘analgesic ladder’
  • Discusses how emotions contribute to pain
  • Identifies appropriate postoperative analgesic regimes including types of drugs and doses
  • Explains how to manage ‘rescue analgesia’ for the patient with severe pain
  • Lists the complications of analgesic drugs
 A,C,E 1
PO_BK_08

In respect of PONV:

  • Recognises the impact of PONV
  • Lists the factors that predispose to PONV
  • Describes the basic pharmacology of anti-emetic drugs
  • Describes appropriate regimes for prevention and treatment of PONV
 A,C,E 1
PO_BK_09 Describes the possible causes and management of postoperative confusion A,C,E 1
PO_BK_10 Describes the causes and management of postoperative hypotension and hypertension A,C,E 1
PO_BK_11 Identifies premorbid disease states that may require patients to have higher (level 2 or 3) levels of care in the postoperative period. A,C,E 1,2
PO_BK_12 Describes the prevention, diagnosis and management of postoperative pulmonary atelectasis A,C,E 1
PO_BK_13 Lists the appropriate discharge criteria for patients leaving the recovery room and day stay patients A,C,E 1
PO_BK_14 Explains the importance of following up patients in the ward after surgery A,C,E 1,2,3

Skills
Competence Description Assessment Methods GMP
PO_BS_01

Performs safe tracheal extubation

 A,D 1
PO_BS_02

Evaluates neuromuscular blockade using a nerve stimulator

 A,D 1,2
PO_BS_03

Transfers an unconscious patient from the operating theatre to the recovery room

 A,C,D 1,2

Knowledge
Competence Description Assessment Methods GMP
PO_BS_04 Turns a patient into the recovery position A,D 1
PO_BS_05 Makes a clear handover to recovery staff of perioperative management and the postoperative plan A,D,M 1,3
PO_BS_06 Prescribes appropriate postoperative fluid regimes A,C 1
PO_BS_07 Assesses postoperative pain and prescribes appropriate postoperative analgesia A,C,D 1,3
PO_BS_08 Manages postoperative nausea and vomiting A,C 1
PO_BS_09 Assesses postoperative confusion A,C 1
PO_BS_10 Recognises when discharge criteria have been met for patients going home or to the ward A,C,D 1,2,3
PO_BS_11 Undertakes follow-up visits to patients after surgery on the ward A,C,D 1