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The following policies should be immediately and reliably available at sites where anaesthesia and sedation are provided:
- guidelines for the checking of anaesthetic machines127
- guidelines for the management of anaesthetic emergencies, including anaphylaxis,55,172,173malignant hyperpyrexia and major haemorrhage
- periarrest and cardiac arrest algorithms174
- difficult airway management, including the ‘can’t ventilate, can’t oxygenate’ scenario.133
The following policies should be held and easily accessible for:
- WHO checklist, including time out4
- ‘Stop Before You Block’175
- ‘Do not attempt cardiopulmonary resuscitation’
- death in the operating theatre21
- major incident
- infection control (including antibiotic prophylaxis, staff protection and post exposure prophylaxis)148
- prevention of hypothermia134
- major haemorrhage176
- blood and blood products administration177...
Patient care should be transferred to staff who have been specially trained in recovery procedures and reached locally or nationally agreed prescribed competencies, such as the UK National Core Competencies for Post-Anaesthesia Care 2013.41,180,181
On occasions, patients may be handed over to the recovery practitioner with a supraglottic airway device in place. The person taking over direct clinical care of such a patient should be specifically trained in the management and safe removal of the airway device.131
If a patient is transferred to the recovery unit with a tracheal tube in situ, the anaesthetist remains responsible for the removal of the tube but may delegate its removal. Delegation should be to an appropriately trained member of staff who is prepared to accept this delegated responsibility.180
An anaesthetist should have overall responsibility for the transport of patients from theatre to the recovery unit.182
Anaesthetists or a delegated AA should formally handover the patient, and should remain in the recovery unit if their input is required. They should leave the patient in a stable condition.131,183,184
The patients anaesthetist should retain overall responsibility for the patient during the recovery period and should be readily available for consultation until the patient is able to maintain their own airway, has regained respiratory and cardiovascular stability and is able to communicate, unless this care has been handed over to another named anaesthetist. Where the patient’s anaesthetist is not the...
The care of an individual patient should be delivered on a one to one basis until the patient is able to maintain their own airway, has respiratory and cardiovascular stability and is able to communicate appropriately. All recovery units should be staffed to a level that allows this to be routine practice and the recovery staff should not have any...
A minimum of two members of staff should be present (of whom at least one should be a registered practitioner) when there is a patient in the recovery unit who does not fulfil the criteria for discharge to the ward. If this level of staffing cannot be assured, an anaesthetist should stay with the patient until satisfied that the patient...
