Settings for the practice of anaesthesia and recovery :
The nurse delivering care in the anaesthetic and recovery areas is a member of the multi-disciplinary team responsible for the safety and quality care of all patients undergoing treatment necessitating anaesthetic/sedation/analgesia in the following clinical settings:
The nurse delivering care in the anaesthetic and recovery areas is a member of the multi-disciplinary team responsible for the safety and quality care of all patients undergoing treatment necessitating anaesthetic/sedation/analgesia in the following clinical settings:
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Registered Practitioners Working in Anaesthetics and Recovery
Anaesthetist
Anaesthetics is the largest hospital-based speciality in the UK1 Anaesthetists work in all of the above fields. Anaesthetic care within the peri-operative pathway can only be provided by an anaesthesia team led by consultant anaesthetists. The anaesthetist alone can deliver anaesthesia autonomously. The only other non-medical staff permitted to deliver anaesthesia in the UK is the Physicians’ Assistant [Anaesthesia] who deliver anaesthesia under supervision by a Consultant Anaesthetist. The anaesthetist remains responsible for his patient throughout the perioperative journey until discharge from PACU. Whilst in PACU the recovery room nurse carries out anaesthetic orders and refers any major problem back to the anaesthetist in charge of the patient. The anaesthetist is required to have a trained practitioner2 [Anaesthetic Nurse or Operating Department Practitioner] working alongside him in the delivery of anaesthesia.
1. British Journal of Anaesthesia, 119 [S1] : i99-i105 [2017]
2. Association of Anaeasthetists [2018] The Anaesthetic Team accessed at : https://anaesthetists.org/Portals/0/PDFs/Guidelines%20PDFs/Guideline_The%20Anaesthesia%20Team_2018.pdf?ver=2019-01-08-163915-087×tamp=1546967138246&ver=2019-01-08-163915-087×tamp=1546967138246 on 2.02.2021
Physicians Associate [PA(A)] & Anaesthetic Associate
Anaesthesia Associates are highly trained, skilled practitioners that work within the anaesthetic team under the supervision of a consultant anaesthetist. All qualified AAs have successfully completed an Anaesthesia Associate training programme offered by 3 UK universities.
AAs provide perioperative patient care , generally in 2:1 capacity depending on patient acuity. In a 2:1 model, one consultant anaesthetist supervises two AAs, or a trainee anaesthetist and an AA, providing anaesthetic care in two adjacent operating theatres.
Physicians Associates are medically trained, generalist healthcare professionals, who work alongside doctors and provide medical care as an integral part of the multidisciplinary team. Physician Associates are practitioners working with a dedicated medical supervisor, but are able to work autonomously with appropriate support. Physician Associates work within a defined scope of practice and limits of competence but PAs are not trained or able to provide any form of anaesthetic provision or duties within the field of anaesthesia. There are many UK universities offering the PA training’.
AAs provide perioperative patient care , generally in 2:1 capacity depending on patient acuity. In a 2:1 model, one consultant anaesthetist supervises two AAs, or a trainee anaesthetist and an AA, providing anaesthetic care in two adjacent operating theatres.
Physicians Associates are medically trained, generalist healthcare professionals, who work alongside doctors and provide medical care as an integral part of the multidisciplinary team. Physician Associates are practitioners working with a dedicated medical supervisor, but are able to work autonomously with appropriate support. Physician Associates work within a defined scope of practice and limits of competence but PAs are not trained or able to provide any form of anaesthetic provision or duties within the field of anaesthesia. There are many UK universities offering the PA training’.
Anaesthetic Nurse & Operating Department Practitioner [ODP] in the Anaesthetic Room
The anaesthetic room is where the patient is prepared for theatre. IV cannulation, setting up of monitoring, delivery of drugs and fluids, securing the airway : all take place in this room.
The role of Registered Nurse or ODP working alongside the anaesthetist is collaborative and ensures patient safety throughout any procedure.
A brief list of duties:
The role of Registered Nurse or ODP working alongside the anaesthetist is collaborative and ensures patient safety throughout any procedure.
A brief list of duties:
- Ensuring the environment / equipment is safe
- Checking equipment is in place and ensuring it is working
- Preparing drugs to make available for anaesthetist
- Assisting anaesthetist with intubation
- Assisting anaesthetist with cannulation, line insertion
- Assembling and making ready equipment for IVI, monitoring, catheterisation, warming
- Caring for patient from check into theatre until admission to PACU.
- Monitoring local anaesthetic cases.
REGISTERED NURSE : OPERATING DEPARTMENT PRACTITIONER IN THE PACU
The Registered Nurse/ODP
- Both nurse and ODP working in the PACU assume care of the patient in loco anaesthetist from the moment the patient is handed over by the anaesthetist until discharged. The nurse/ODP carry out anaesthetic instructions and refer any problems they cannot resolve back to the anaesthetist. The anaesthetist remains overall responsible for the patient during this period.
- Take over care of patient in handover, note surgical, anaesthetic and surgical history, understand potential risks and immediately prioritise care : Airway, Breathing, Circulation
- Ensure airway, breathing and circulation are assessed until stable. Using a systemic A-E approach ensures that any deviation from normal is assessed, appropriate intervention made and evaluated.
- Ensure patient comfort, administration of analgesia, anti-emetics as necessary. Other comfort measures taken, patient reassured.
- Patient assessed for discharge to ward or other
- All paper work signed and up to date : handover.
- Dependent on place of work and training. Scope can include cannulation, IV administration of fluids and drugs, intubation with supra-glottal device, care of ventilated patient, extubation.
NURSING ASSOCIATE
[now join the nursing associate part of NMC Register which opened in January 2019]
- The Nursing Associate is a new role designed to bridge the gap between healthcare assistant and registered nurse. NMC became the legal regulator for nursing associates in July 2018. Nursing Associates work towards an NMC Validated Foundation degree. Training course lasts 2 years full time. On graduating they start working as Nursing Associates in their area of choice and potentially in the post anaesthetic care unit.
Non Registered practitioners working in PACU
Associate Practitioner [Associate or Assistant practitioner]
These are experienced staff working in support roles, alongside qualified healthcare professionals. Although not registered they work across the NHS in most departments including theatre [as scrub nurse] and monitoring patients recovering from surgery under indirect supervision.
Health Care Assistant [HCA]
A healthcare assistant [HCA] works under the supervision of a registered nurse [RN] to provide direct care to patient across a variety of settings, including [theatre and recovery]. Duties may include:
- Wash and dress, serve meals, help ambulate, make beds
- Monitor patients' condition by taking temperatures, pulse, respirations
Students
- Students and qualified personnel seeking experience in PACU are usually allocated for a short period of time to gain experience of PACU nursing. They follow a local in house training programme.
- Pre-Registration nurses and Nursing Associates
- Pre-Registration ODP’s
- Paramedics
- Midwives
- Other
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