Q2: What are the minimal staffing recommendations for PACU?

BARNA Standards of Practice [2]:

‘Reception of patient:(the patient may be unconscious or emergent from that state) Staff ratio: 1:2 (one patient/two nurses) – to undertake handover/prioritise immediate care/set up monitoring).  The skills of the first nurse must be appropriate for the acuity of case.  The helper may be a novice nurse or member of the perioperative team.

Stabilisation period:(self ventilating with no airway adjuncts or needing respiratory assistance; the patient’s clinical condition stabilises through this period to full recovery but may regress back along the clinical continuum).  Staff ratio: 2:1 (two patients/one nurse) skills of nurse must be appropriate to acuity of cases.  If patient’s condition deteriorates staff must be reallocated promptly.

Fit for discharge:(has met all local discharge criteria – is stable and comfortable).  Staff ratio: 3:1 (three-patients/1 nurse). The nurse looking after three patients must be experienced and may be assisted by novice nurse or member of the perioperative team’.

Association of Anaesthetists of Great Britain and Ireland [1]:

‘No fewer than two staff [of whom at least one must be a registered practitioner] should be present when there is a patient in PACU who does not fulfill the criteria for discharge to the ward’.

Royal College of Anaesthetists [3]:

‘Until patients can maintain their airway, breathing and circulation they must be cared for on a one-to-one basis

At least two appropriately trained staff should be present in the recovery room while there is a patient who does not fulfill the criteria for discharge to the ward.

It is difficult to give guidance on the exact numbers of staff required for any particularly recovery area.  The staffing levels will depend on factors such as the case mix, numbers of patients and the number of operating lists per session.’

BARNA advice:

Staffing the PACU is an ongoing intractable problem.  All statements on staffing are based on minimal staff to patient ratios which are dependent on the clinical status of the patient. However, to adjust staff numbers to patient throughput accurately throughout the shift, matching patient acuity to staff expertise is very difficult.   It remains doubtful that a ‘magic formula’ can be developed to fit this constantly changing, dynamic clinical area.   BARNA has developed work around this topic [see audit section].   BARNA would recommend auditing variables that affect staff –patient ratios [delayed discharge being one important factor].   Safe staffing the PACU is still dependent on the expertise of the PACU manager who can adjust staffing if necessary on a day to day basis.

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Sources:

[1] Association of Anaesthetists of Great Britain and Ireland [2012,] Draft report of the AAGBI Immediate Post-anaesthetic Recovery Working Party. Association of Anaesthetists of Great Britain and Ireland, London
[2] British Anaesthetic and Recovery Nurses Association:Standards of Practice [reviewed 2012]  British Anaesthetic and Recovery Nurses Association, London
[3] Royal College of Anaesthetists [2009] Guidance on the provision of anaesthesia services, Chapter 4: Post-operative care. Royal College of Anasthetists, London


Barna. British Anaesthetic and Recovery Nurses Association