INDIANA UNIVERSITY DEPARTMENT OF ANESTHESIOLOGY
PACU (POSTANESTHESIA CARE UNIT) Rotation
Goals and Objectives
GOALS and OBJECTIVES:
The goal of the PACU Rotation at the Indiana University School of Medicine is to train
physicians to be competent and compassionate physicians when caring for patients in the PACU.
This rotation is designed to develop the appropriate knowledge, understanding and application of
anesthesia principle in order to provide safe anesthesia management for the POCU patient.
Basic PACU Resident Duties:
Basic duties for the PACU/POCU residents include:
1. The resident, during the PACU rotation, will be available for duty from 0700 – 1600
hrs.
2. During the PACU rotation the resident will learn to evaluate the post anesthetic
patients. This will include but not be limited to complications associated with
emergence, pain control, airway, peripheral nerve blocks and co-existing disease
states the may effect the patients overall post-anesthetic course
3. Attend didactic conferences
4. Take night call on a rotating schedule
5. Respond to requests for anesthesia consults in a timely fashion
6. Maintain a personal program of self-study and professional growth
7. Complete medical records promptly
8. Document all duty hours
9. Document all procedures
10. Monitor self for fatigue
11. Dress appropriately
12. Act in a professional and ethical manner
13. Complete the appropriate evaluation instruments used by the department, including
QA forms
Educational Strategy:
The PACU Rotation is a two week rotation. During this period, the resident will be involved in
direct patient care with the attending staff. When indicated, immediate patient care needs will be
discussed with the attending physician in charge of the overall anesthetic management for the
individual patient. Dr. Robert Byers, the Medical Director of the PACU/POCU, is responsible
for the administrative aspects of the PACU rotation. Dr. Byers will be responsible for the
educational agenda for this rotation. He will provide residents with a selected group of review
and journal articles. Dr. Mark Tasch will serve as the PACU liaison in Dr. Byer’s absence. The
PACU residents will provide the faculty with an overview of all ongoing patient care issues in
the PACU as needed. During the rotation residents are expected to participate in journal clubs
and morbidity and mortality conferences (QA).
During the rotation in ambulatory anesthesia, residents are expected to participate in journal
club, and morbidity and mortality conferences (QA).
Interactive teaching during the POCU/PACU rotation will occur:
1. During both of these rotations faculty are available by pager to assist resident in their
assessment and evaluation of patients on an ongoing basis
2. Residents are expected to discuss issues associated with patient care in both venues as
appropriate
3. Residents also interact with faculty during post-op rounding during the PACU rotation.
Given that the PACU resident has interacted with the vast majority of these patients
during their stay in the PACU, it seems reasonable that the PACU resident round on these
patients the day after surgery in order to better appreciate the longer term impact of
anesthesia and to provide continuity of care. Residents and faculty have the opportunity
to discuss patients raise issues of particular interest.
4. The POCU/PACU resident is provided with a syllabus of material that is meant to assist
them in their education within this area. Dr. Byers and Dr. Harris as well as any other of
the faculty are available to discuss issues associated with resident as appropriate.
Core Competencies:
The six core competencies are used as a template to evaluate residents during all Anesthesia
rotations. The terms used to define these competencies are similar to those used for other
rotations. The Goals and Objectives that follow have been specifically modified to meet the
needs of the specific teaching rotation in which you are to participate. These Goals and
Objectives are not intended to be comprehensive but have been developed to help you acquire
the core competencies in the area of Clinical Anesthesia. These core rotations should serve as
the foundation upon which the subspecialty anesthesia rotations are based. We ask you as the
learner to consider how each of the subcategories within these six competencies might relate to
cognitive, motor and affective characteristics of your education and your professional behavior.
If while reading this document you discover an area that requires revision or improvement please
bring these issues to the attention of either the Course Director or the Program Director. We seek
changes that will improve your educational experience.
EDUCATIONAL OBJECTIVES
Medical Knowledge:
After completing this rotation, residents will have gained knowledge and practical experience in
the care of peri-operative patients by:
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1. Defining the disease entities leading to the need for anesthetic interventions
2. Understanding the following post-op complications: airway obstruction, stridor,
laryngeal spasm, hypoxia, hypoventilation, respiratory distress, pneumothrorax,
pulmonary embolism, hypovolemia, cardiac arrhythmias, cardiac arrest, incomplete
reversal of muscle relaxants, over dose of narcotic analgesics, post operative nausea
and vomiting, hyper and hypothermia, hypo and hyperglycemia, post operative pain,
complications of blood transfusion, malignant hyperthermia, anaphylaxis, emergence
delirium and prolonged recovery
3. Developing the following skills: management of airway obstruction, laryngeal spasm
and stridor, emergency intubation or re-intubation, placement of intravenous and
arterial catheters, interpretation of postoperative chest radiographs and ECGs.
4. Depending on patient flow in the units, some residents may also gain experience in
placement of peripheral nerve blocks, peripheral nerve and plexus catheters and
epidural catheters to provide postoperative pain relief, set up and trouble shoot
epidural and PCA pumps
5. Understanding the role of an acute pain consultant and be able to act appropriately to
care for the needs of patients experiencing acute severe pain after surgery
6. Learning the importance of professional, collaborative interactions with all members
of the post anesthesia care team including nursing staff, surgeons and fellow
anesthesiologists.
Patient Care:
Using the above medical knowledge the resident is expected to:
1. Evaluate patients and develop an appropriate anesthetic plan for patients during the
PACU/POCU rotation
2. Plan a comprehensive approach to problems involving recovery room patients while
on the PACU rotation
3. Plan a comprehensive plan for pre-operative assessment and intra-operative
management of the surgical patient when on the POCU rotation
4. Demonstrate the ability to function as a PACU/POCU consultant
5. Understand the administration/complications/benefits of the various pharmacologic
agents sufficiently to make sound medical judgments appropriate for PACU/POCU
6. Have an understanding of the importance of continuing post anesthesia care;
understand how to care for a patient suffering from post operative airway
compromise; post operative cardiac and respiratory instability; post operative pain:
nausea and vomiting and delayed recovery.
7. Demonstrate the ability to perform a thorough examination of the patient to determine
the cause of immediate post anesthesia or post surgical complications; the resident
will demonstrate appropriate care and compassion for patients in the PACU.
8. Understand the importance of behaviors that facilitate patient care in the PACU and
demonstrate these behaviors effectively; the resident will demonstrate good judgment
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in the care of the post anesthesia patient by understanding when, how and who to call
for help in dealing with post anesthesia complications
Interpersonal and Communication Skills:
After completing this rotation, residents will have gained experience and competence in:
1. Obtaining an accurate patient history appropriate in order to provide care to the postoperative patient
2. Completing an informative, legible medical record
3. Communicating skillfully with patients and family members
4. Communicating information about anesthetic procedures with other colleagues
including referring physicians, nurses, and workers on ancillary services
5. Effective counseling of patients and families as indicated regarding patients
progression through the PACU in a fashion that is readily understood
Professionalism:
After completing this rotation, residents will have gained experience and competence in:
1.
2.
3.
4.
Acting in a professional manner while providing patient care
Demonstrating reliability and dependability
Exemplifying compassionate and appropriate patient care
Acquiring teaching skills essential for creating a positive learning environment,
including involvement in the education of medical students
5. Showing respect for patients
6. Providing for the emotional needs of patients
Systems-Based Practice
After completing this rotation, residents will have gained experience and competence in:
1. Understanding their role as a patient care advocate
2. Becoming familiar with the costs associated with the delivery of anesthesia care
3. Incorporating the concepts of cost-benefit analysis when considering therapeutic
options
4. Interpreting the constraints associated with management of the operating room and be
able to integrate this understanding into best patient care practices
5. Emphasizing safety for the patient as well as operating room personal
6. Obtaining a better understanding of the tools that are being utilized to assess best
practices in anesthesia by organizations such as Magnet and Leapfrog
7. Working towards developing team building skills
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Practice Based Learning and Improvement:
After completing this rotation, residents will have gained experience and competence in:
1. Self-directed learning
2. Becoming more efficient at locating medical information associated with acute pain
3. Reviewing the medical literature related to the field of acute pain and integrating this
information with the care of the patient
4. Learning to better utilize information technology to access on-line medical
information pertaining to innovative diagnostic and therapeutic modalities in the area
of acute pain
5. Transferring knowledge about acute pain to other members of the healthcare team
(medical students, ancillary care personal and nursing staff)
Trainee Evaluations:
The Clinical Competency Committee (CCC) meets every other month to evaluate the progress of
the trainees. Specifically addressed are the six basic competencies and the PACU/POCU
specific competencies outlined above. The instruments used to assess their progress include an
evaluation form which utilizes a scaled five point Likert scoring system which assesses each of
the six competencies. In house testing is also performed twice yearly to insure that the trainees
are acquiring the knowledge associated with the provision of a safe anesthetic. Residents are
expected to take the in-training examination administered by the American Society of
Anesthesiologists/American Board of Anesthesiology (ASA/ABA).
On a more informal (and potentially more important) level, members of the teaching faculty
evaluate our trainees daily and provide them real-time feedback concerning their performance in
the delivery of anesthesia services. Informal discussions with the PACU/POCU residents address
any deficiencies in patient care or knowledge base. Additionally, we try to know our trainees
personally to better understand and/or address underlying stressors or personal issues that may
interfere with learning and performance.
Every six months, the American Board of Anesthesiology requires that the Clinical Competency
Committee submit a Resident Training and Evaluation Report. In addition to the basic
competencies, we submit our evaluation of a trainee’s progress in the following areas:
1.
2.
3.
4.
5.
6.
Demonstrates ethical/moral behavior
Is reliable, conscientious, responsible and honest
Learns from experience; knows limits
Reacts to stressful situations appropriately
Has no documented abuse of alcohol or illegal use of drugs during this report
period
Has no cognitive, physical, sensory or motor impairment that precludes individual
responsibility for any aspect of anesthetic management
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7.
8.
Demonstrates respect for the dignity of patients and colleagues
Has no restriction, condition, limitation or revocation of license to practice
medicine
Understands anatomical, physiological, and pathophysiological concepts of organ
disease that culminates in the need for solid organ transplant
Collects and uses clinical data
Recognizes the psychological factors modifying pain experience
Communicates/works effectively with patients/colleagues
Demonstrates appropriate concern for patients
Demonstrates commitment to life long learning
Adapts and is flexible
Is careful and thorough
Generates complete, legible, and accurate medical record
Possesses business skills for effective practice management
Uses information technology to optimize patient care
Is an advocate for quality care
Recognizes gaps in knowledge and expertise
Demonstrates continuous practice improvement
Uses appropriate technical skills in diagnostic and therapeutic procedures
Completes study of management of acute pain, cancer pain, and chronic pain
9.
10.
11.
12.
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15.
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Suggested Readings:
Suggested reading assignments to expand knowledge and patient care for this rotation include
but are not limited to the most recent editions of the following textbooks:
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Clinical Anesthesia 4rd Edition-Morgan, Mikhail & Murray.
Clinical Anesthesia 6th Edition-Barash, Cullen, Stoelting.
Anesthesia and Co-existing Disease-Stoelting & Dierdorf 5th Edition
Pharmacology and Physiology in Anesthesia Practice-Stoelting & Hillier
Miller’s Anesthesia 7th Edition
AHA Guidelines for Advanced Cardiac Life Support
Annual Refresher Course Lectures and Basic Science Reviews of the ASA
(published annually)
For guidance regarding regional analgesia for both operative and post-operative pain control the
most recent editions for the following textbooks are recommended:


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Atlas of Regional Anesthesia – Brown
Neural Blockade – Cousins
Peripheral Nerve Blocks: Principles and Practice—Hadzic and Vloka
Regional Block – Moore
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Review articles on PACU/POCU topics in the following peer reviewed journals provide useful
reading:
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Anesthesiology
Anesthesia and Analgesia (especially Anesth. Analg. 2002; 94: 1351-64.)
British Journal of Anesthesia
Regional Anesthesia and Pain Medicine
Selected pertinent review and Journal articles per Dr. Byers
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