Post-Sedation Nursing Care
The Postoperative Care Area must meet criteria established by the American Society of
Anesthesiologists, American Association of Nurse Anesthetists, and the American Society of Post
Anesthesia Nurses.
Post-procedure recovery and monitoring depends the following:
Procedure performed
Length of procedure
Pre-procedure physical condition
Presence of intra-operative complications
Medication administered (including reversal agents)
Quantity of medication administered
Post-procedure monitoring and discharge policies are required by accrediting bodies and
recommended by professional practice organizations. Purposes of post-procedure monitoring:
Assure the return of physiologic function prior to discharge or return to the inpatient setting.
Provides a time to assess, diagnose, and treat complications
Provides a time period for the patient to meet institutionally approved discharge criteria.
Provides for patient and family teaching prior to discharge
To avoid allegations of premature patient discharge, mechanisms must be in place to assess
home readiness.
Documentation of discharge based on adherence to specific objective clinical parameters is also
required. The American Society of Peri-Anesthesia Nurses identifies characteristics unique to
peri-anesthesia nursing practice. Nurses engaged in the post-procedure management of patients
receiving conscious sedation participate in post-anesthesia phase II as defined by the American
Society of Peri-Anesthesia Care Nurses. However, depending on the level of sedation or in the
event of an adverse reaction, the nurse must be capable of providing acute emergent care.
Transport to the PACU must be accomplished in a safe manner. Oxygen equipment should be
available for transport. The patient is accompanied by the registered nurse participating in the
procedure who is knowledgeable about the patient's condition. Verbal report must be given to the
registered nurse assuming care of the patient. Documentation of the transfer of care should be
recorded in the initial assessment area of the post-procedure record. Post-procedure
documentation should include the following:
Initial assessment
Post-procedure recovery scoring
Graphic vital signs recording area
A post-procedure recovery scoring mechanism was introduced into clinical practice in 1970 by
Aldrete and Kroulik. Modifications of the Aldrete Scoring System have been used since its
original inception. The Aldrete system assigns a predetermined score to objective criteria, which
include the following:
Activity
Respiration
Circulation
Consciousness
Oxygenation
Aldrete Scoring System
Assessment Category
Activity
Respiratory
Cardiovascular
Consciousness
Oxygenation
Score
Able to move all 4
extremities on
command
2
Able to move 2
extremities on command
1
Unable to move
0
Able to cough and
breath deeply
2
Dyspnea or limited
breathing
1
Apnea
0
BP and HR + 20% of preanesthetic level
2
BP and HR + 20% to 50%
of pre-anesthetic level
1
BP and HR -4- 50% of
pre-anesthetic level
0
Fully awake (able to
answer questions)
2
Arousable on calling
(arousable only to
calling)
1
Unresponsive
0
Able to maintain 02
saturation > 92% on
room air
2
Needs 02 inhalation to
maintain saturation >
90%
1
02 saturation < 90%,
even with 02 supplement
0
Objective clinical parameters based on physiology not "the clock". A post-procedure scoring
system must be clearly understood by the nursing staff to provide accurate documentation and
assure the safe discharge of the patient when all discharge criteria have been met. Criteriabased recovery parameters provide a mechanism to objectively assess the needs of the patient.
Conscious Sedation Discharge Criteria
Respiratory assessment
Retains the ability to maintain and protect the airway
Displays no signs of respiratory distress (snoring, stridor, suprasternal retraction, decreased 02
saturation, or respiratory rate)
Demonstrates the ability to cough
Tolerates liquids/light nourishment
A minimum of 30 minutes after the administration of the last dose of narcotic
Patients treated with reversal agents (flumazenil/naloxone) are monitored for a minimum of
120 minutes after the administration of the reversal agent
Consciousness
Fully oriented to time, person, and place or return to baseline mentation
Absence of vomiting; patients who have been treated for vomiting must retain oral fluids and
demonstrate the ability to swallow and cough
Dizziness or lightheartedness (if present) does not interfere with mobility
Able to void (contact MD if has not voided in 8 hours)
Circulation
Stable vital signs for a minimum of 30 minutes
Activity
Performs age- appropriate ambulation
Demonstrates controlled, coordinated movements
Presence of a responsible adult for discharge and home environment
Oxygenation and color
The patient maintains oxygen saturation > 95% on room air or attains preprocedure oxygen
saturation value
Skin color is pink
Procedure site
No bleeding on the dressing, dressing dry and intact
Pain
The patient shall have minimal or no pain prior to discharge
The requirement to have a patient void after the procedure is not universally accepted.
Patients receiving intravenous conscious sedation may not have the normal urinary retention
experienced by postoperative surgical patients, and voiding is generally not a problem.
However, in the presence of intravenous narcotics, patients may experience some urinary
retention with altered bladder tone. Patients who have not voided must be instructed when to
return to the treatment facility in the event of bladder distention or the prolonged inability to
void.
POST-PROCEDURE TEACHING AND INSTRUCTION
Post-procedure teaching is conducted in the presence of the responsible adult assuming care of
the patient on discharge.
Written discharge instructions include:
Addressing medications
Diet
Procedure specific information
Activity levels and restrictions (i.e., driving)
When to return to MD's office
What to do in the event they can't void
Use of written discharge instructions protects both the facility, nurses and patient
POST-PROCEDURE FOLLOW-UP
Methods of gathering data include the following:
Patient questionnaire
Telephone interview
Satisfaction survey
The purpose of post-procedure assessment is to evaluate the following:
Incidence of complications related to the administration of conscious sedation
Delayed recovery
Procedural complication rate
Return to function
SUMMARY
Use of discharge criteria and the post-procedure recovery period provides time to assess and
verify the patient's return to preprocedure physiologic status. Use of scoring mechanisms,
assessment of activity level, post-procedure teaching, and the provision of discharge instructions
prepare the patient to return to the primary care setting or home.