Improved patient handover and understanding of post-operative and post-anaesthesia complications will elevate the practice of Intensive Care Unit (ICU) nurses when recovering immediate post-operative patients and boost patient safety, according to a leading perioperative nurse researcher.

Dr Paula Foran, the Education Officer for the Australian College of Perioperative Nurses, says ICU nurses providing immediate post-operative and post-anaesthesia nursing care face different challenges to nurses on the surgical ward.

With many patients transferred directly to ICU post-surgery, bypassing the Post Anaesthetic Care Unit (PACU), or transferred in the early post-operative period after a short stay in PACU, Dr Foran says it’s crucial ICU nurses have a good knowledge about the range of patient complications that can occur following surgery and anaesthesia.

“If you are about to take responsibility for a patient and you do not fully understand the general and specific complications for that surgical procedure, you must ask, possibly at the time of handover,” she says.

Surgical patients can be directly admitted to ICU for reasons ranging from a pre-existing illness to major surgical procedures, such as a coronary artery bypass grafting that requires ongoing ventilation support and management.

Patients can also be admitted to ICU due to complications from either surgery or anaesthesia, following a major haemorrhage or major blood transfusion, and after developing life-threatening conditions such as malignant hyperthermia or anaphylaxis.

While surgical techniques and anaesthetic agents have evolved in the past 70 years, Dr Foran says the main purpose of providing immediate post-anaesthetic and post-operative care in PACU or ICU has stayed the same.

“The focus remains on critical evaluation and stabilisation of patients after surgery, with an emphasis on preventing and treating complications arising from either the anaesthetic or the surgical procedure,” she says.

Dr Foran, a perioperative nurse with 30 years’ experience, co-authored a new chapter for the salient Australian text in intensive care nursing, the Australian College of Critical Care Nurses’ (ACCCN) Critical Care Nursing 3rd Edition, in a bid to assist ICU nurses understand the challenges of post-operative and post-anaesthesia nursing care.

Research shows surgical patients are prime candidates for clinical deterioration with complications from surgery estimated to comprise about 40 per cent of all adverse events.

While mortality rates have improved in the past decade, largely due to better recognition and treatment of patient deterioration, failures in the process continue to occur.

Studies reveal that timely and appropriate surgical intervention combined with high-quality pre and post-operative care may be the key to preventing deaths in the first 48 hours after surgery.

The Australian National Consensus Statement on essential elements for recognising and responding to clinical deterioration reports that measurable physiological abnormalities usually occur prior to adverse events, such as cardiac arrest and death.

Dr Foran says the consensus statement suggests that the early recognition of changes in a patient’s condition, followed by prompt and effective treatment, can minimise poor outcomes.

In the past few decades, caring for patients during anaesthesia and post-anaesthesia, known as perianaesthesia nursing, has grown to become a recognised nursing specialty in its own right.

Postgraduate education in this vital field is supporting nurses to develop expertise in perianaesthesia nursing.

Many postgraduate nursing university courses offer a perianaesthesia stream while the Australian College of Perianaesthesia Nursing (ACPAN) also offers a fellowship program, including credentialing.

Dr Foran says experienced PACU nurses have knowledge of both general and specific complications associated with anaesthesia and surgical procedures when caring for patients postoperatively and would love to share it.

“General complications may occur in any patient - however, each anaesthetic or surgical procedure may have its own explicit complications.”

Dr Foran says patient handover is a crucial component of nursing care that helps guide post-operative assessment and management but research suggests that technical and communication errors are rife during handover, jeopardising patient safety.

While there is no standardised approach to patient handover, Dr Foran says the treating anaesthetist must provide handover to the nurse caring for the patient at the time of transfer of care.

A range of handover tools are available, including the iSoBAR (identification, situation, observations, background, assessment, responsibility) and ISBAR (identification, situation, background, recommendation) checklists.

But Dr Foran says it’s not the specific handover tool but the compliance with the chosen tool that’s imperative for patient safety.

The quality of the handover is critical to enabling ICU nurses to safely assume responsibility for their patients, she adds.

“It is important for nurses to understand the handover process, knowing what information needs to be gleaned from the handover as they accept responsibility for their patients’ care,” Dr Foran says.

“It is therefore essential that the nurse understands what complications are possible for each individual patient.”