Implement this Preventive Strategy, Save a Life An additional assessment could be invaluable for your patient BY REBECCA CRAIG, RN, CASC, AND CASSIE SEILER, RN

In the ASC community, we follow safety protocols of many kinds

each and every day to keep our patients out of harm’s way. However, I challenge you to go one step further for your pedi- atric population. Years ago, after a near miss, we implemented a new process that has proven to be priceless. When the nursing staff in recovery determine a pediatric patient is ready for discharge, they notify a manager— team leader, clinical coordinator or the clinical director—who then must “lay eyes” on the patient and review the phy- sician’s orders and nursing documenta- tion to ensure we have done everything in our power to confirm the patient is ready for discharge. This additional manager assessment includes a visual assessment of the patient to check for their level of consciousness, current oxygen saturation levels and other vital signs and a review to confirm com- plete resolution of any complications/ care interventions in surgery or recov- ery, medication use, appropriate family teaching/discharge plan and confirma- tion of appropriate timeframes for dis- charge specific to type of surgery and after any narcotics. We cannot guaran- tee the care or home environment our pediatric patients will be subject to upon discharge, but this second pair of eyes to assess has been extremely valuable and has preemptively caught potential complications numerous times. Ensuring the children we perform

surgery on, especially the ENT and den- tal patients, have met discharge criteria as evidenced by the additional assess- ment and the documentation in our med-

8 The Phase II Discharge Criteria for Harmony Surgery Center

a. General/Monitored Anesthesia Care (MAC/IV Conscious sedation) 1) Awake/Alert 2) Vital signs stable within 20 percent of pre-procedure values

3) Minimum 30 minutes after last IV narcotic/sedative. Exception: Propofol Sedation: May discharge when patient meets discharge criteria versus a minimum time requirement

4) Pain rating <4 or consistent with pre-procedure level of baseline pain

5) Oxygen saturation >90 percent on room air or physician ordered supplemental oxygen planned for home use (or consistent with pre- procedure values). Pediatric patients are to be > 92 percent on room air

6) Controlled nausea/vomiting 7) Wound site acceptable 8) No signs/symptoms of procedure-related complications

9) Able to ambulate steadily without vertigo or motor function impairment. Exception: Pediatric patients may be carried by parents

10) No motor function impairment or limitations (or consistent with pre-procedure motor abilities).

ical record is invaluable. A few surgeons have gone a step further for their pedi- atric patients with a history of obstruc- tive sleep apnea and have performed surgery to remove their tonsils and adenoids. They write orders for these patients to be kept four hours for observation to ensure we have clear evidence these patients can maintain their oxygen saturation above 92 per- cent on room air and do not have any airway complications. It is only after these checks and double checks that any of our pediatric patients can be discharged from the center. In addition, to ensure our facil- ity is hiring and maintaining highly qualified nursing staff, we require all RNs at Harmony Surgery Center to be advanced cardiac life support and pediatric advanced life support certi-


fied. All of our post-anesthesia care unit nursing staff are required to obtain their Certified Ambulatory Perianes- thesia Nurse certification within 18 months of hire.

It is of utmost importance to work

collaboratively with your anesthesia providers, including monitoring safe opioid use and developing non-opioid and multi-modal pain control protocols for all patients, especially pediatrics.

Rebecca Craig, RN, CASC, is a former president of the ASCA Board and the chief executive officer of Harmony Surgery Center, LLC, and Peak Surgical Management, LLC, in Fort Collins, Colorado; Cassie Seiler, RN, is the director of clinical operations at Harmony Surgery Center, LLC, and Peak Surgical Management, LLC. Write them at and

The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.

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