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All institutions should have protocols and the necessary facilities for managing postoperative care and should review and update these regularly.¹⁹²

The following protocols should be held and easily accessible for:

• management of postoperative nausea and vomiting
• pain relief for patients with chronic pain¹⁹⁸
• hypothermia¹⁹⁹
• blood transfusion
• fluid therapy
• acute coronary syndrome
• respiratory diseases
• hypotension
• hypertension
• monitoring following central and peripheral neuraxial blockade²⁰⁰
• escalation to higher levels of postoperative care (e.g. to a critical care unit) should the...

There should be a named lead consultant for the PACU (see Glossary).¹⁸⁵

Processes for the communication and implementation of patient safety alerts should be in place.

Patients should be transferred to the ward, the postoperative care environment or the critical care unit accompanied by two members of staff, at least one of whom should be suitably trained to locally agreed standards.²⁰¹ The anaesthetic record, recovery and prescription charts together with the postoperative plan, should accompany the patient and be clearly communicated to the receiving ward nurse.

Handover, including on moving to the postoperative care environment or to the ICU, should always be to a member of staff who is competent to care for the patient at that time, and this should be clearly documented.²⁰²

All handovers should be structured to ensure continuity of care.^8,203

Staff should complete urgent tasks before information transfer, limiting conversations while performing these tasks (adopting a ‘sterile cockpit’ approach see Glossary).^204,205

If responsibility for care is transferred from one anaesthetist to another, a ‘handover protocol’ should be followed, during which all relevant information concerning the patient’s medical history, medical condition, anaesthetic status, and plan should be communicated.¹⁸²

Standardisation of the handover process can improve patient care by ensuring information completeness, accuracy and efficiency (the use of checklists should be considered). Staff should comply with the local standardised handover processes.^192,206