Transfer of Care
Handoffs are high-risk moments
Every transition - preoperative area to OR, OR to postanesthesia care unit, PACU to phase II or the inpatient unit, and unit to home - is an opportunity for information loss. A complete handoff covers patient identity, procedure performed, anesthetic technique and agents, allergies, current medications, IV access and lines, drains and tubes, estimated blood loss, urine output, fluid replacement, implants, specimens, count status, skin condition, temperature, pain and nausea status, complications and interventions, pending results, and the plan for the next phase.
Accepting the patient
While the report is being given, the receiving nurse performs a quick visual assessment - airway patency, respiratory effort, oxygen saturation, level of consciousness, dressings, drains, and IV patency - then completes a fuller assessment after assuming care. The transferring nurse remains available until the receiving nurse accepts responsibility; abandonment occurs when the patient is left without a qualified caregiver. Transport requires adequate oxygen supply, monitoring appropriate to acuity, sufficient personnel, side rails, and protection of lines and drains.
PACU discharge criteria
Most units use an Aldrete-type score covering activity, respiration, circulation, consciousness, and oxygenation, with a threshold (commonly 8 or greater) plus stable vital signs, ability to protect the airway, controlled pain and nausea, and no evidence of active bleeding. Phase II or ambulatory discharge adds the ability to ambulate and void as appropriate, a responsible adult escort, no driving, and written and verbal instructions.
Traps
Watch for one-way reports with no chance for questions, and for accepting a patient before the report is complete. Rule of thumb: report, verify, assess, then accept.