Discharge Assessment Phase I

• Nurses use protocol set forth by PACU to immediately assess a patient's recovery from anesthesia after surgery. During initial postoperative care, the anesthesiologist should check the patient's airway for solid respiratory function. From there, the patient should be checked for muscular strength and pain control. Any medical devices inserted into the patient, including IVs and catheters, should be checked to make sure they are not compromised. The patient's comfort and anxiety after surgery should also be assessed.
  
  

The Aldrete Scale

• There are several PACU scoring systems for the assessment of anesthesia patients. One of those rating scales is the Aldrete Scale, which was formulated in 1970 and modified in 1992. Aldrete uses a rating scale of zero to two to score five different areas of recovery -- activity, respiration, circulation, consciousness and oxygen saturation. A score of two in each category is considered best in all areas. A patient must have an overall score of at least nine to bypass Phase II and be considered for discharge.
  
  

Discharge Assessment Phase II

• As the patient continues to recover from surgery, the PACU assessment moves into Phase II. This phase is reserved for patients who didn't score well enough to earn a discharge in Phase I. Patients should be showing improvement in key areas that were checked in Phase I, such as respiration and muscle strength. Skin color and condition are also considered during this phase.
  
  

PADSS

• The postanesthesia discharge scoring system (PADSS) is the gauge many hospitals use to assess the patient's readiness for discharge in Phase II. PADSS checks five important areas -- vital signs (blood pressure and pulse), activity, nausea and vomiting, pain and surgical bleeding. Like the Aldrete Scale, patients must score at least a nine in order to be considered for discharge.
  
  

Preparing for Discharge

• Once the patient is ready for discharge, PACU protocol states that there are several steps for preparing the patient to be sent home. Both the patient and any home care providers should understand all discharge instructions. Those instructions should be written out and provided to both the patient and an accompanying adult or guardian, if the patient is a child. That information should include resources and contact numbers in case complications arise. Travel arrangements for the patient to be taken home should also be verified.