How would you manage this situation? Provide rationales for your actions

Question

You have been caring for a 78-year-old woman following a total hip replacement under an epidural block and sedation. You judge that the patient is stable and ready to return to the ward. When the ward nurse arrives, she believes that the patient's BP is very close to triggering a MET call in the ward and is not comfortable taking the patient at this time.

What will be an ideal response?

Answer 1

Answer:
If a scoring system is used to detect deterioration of patients in ward areas, the last set of patient observations should be transcribed onto the ward chart and a score calculated prior to discharge. This should provide a baseline for the ward nurses and alerts the PACU staff if the patient is still not ‘ward ready'.
It is not appropriate to send a patient to the ward when their observations are at, or very close to, triggering a MET call.
If the ward nurse is uncomfortable with the patient's continuing care, discussing with the nurse the parameters the ward will accept (remembering that nurses on the ward may have five postoperative patients, not just one) and keeping the patient a little longer to ensure they are ‘ward ready' may be required.
Caution should be taken if a ward nurse is uncomfortable with a patient's vital signs on discharge. Recent research looking at adverse events in surgical wards reveals that many adverse events may be due to premature discharge from PACU or ICU (Helling, Martin, Martin, & Mitchell, 2014).
It would be prudent to speak to the PACU in charge nurse for guidance, as the patient may need to be transferred to a higher dependency area such as HDU or ICU for postoperative care.