Creating the Perianesthesia Emergency Nurse Resource Role to Prevent Failure-to-Rescue: A Quality Improvement Project

The Perianesthesia Emergency Nurse (PEN) could be considered the rapid response nurse of the postanesthesia care unit (PACU). The role of the PEN was to assist with patients in the PACU showing signs of altered hemodynamics and to deliver prompt interventions. This role was to prevent failure-to-rescue events in the PACU. The PEN facilitated patient transfer to the appropriate ward when the timing was safe. The PEN also acted as a resource for less-experienced staff and for high-risk medications, procedures, and equipment that were infrequently encountered. The PEN collaborated with nursing and medical staff, providing real-time education and support.

Quality Improvement Project using the Institute for Healthcare Improvement Plan-Do-Study-Act worksheet.

On approval for the PEN resource, it was necessary to refine roles and responsibilities. Clinical decision-making, communication skills, critical care experience, and employment greater than 1 year in the institution's PACU were determined to be necessary for success in the role. Additional specialized education was provided on medical event management. Topics included hypoxia, hypotension, and bleeding. Events were categorized by frequency and clinical condition.

The implementation of a specialized resource, or PEN, supported the staff and provided an additional layer of patient safety. Our 2023 data revealed that only 4.8% of patients evaluated by PEN in the PACU required a rapid response call within the first 24 hours post anesthesia compared to 11.1% before the PEN. When surveyed, staff positively endorsed the addition of the PEN in the PACU with 100% of responding nurses considering it a beneficial resource during medical events in the PACU. The PEN program highlighted both gaps and opportunities for practice change in the PACU. Partnership with our anesthesia colleagues has led to change implementation. Examples include patient monitoring during transport and bringing vasoactive drips out with the patient if recently discontinued.

After a successful 8-week pilot, the PEN was incorporated into the PACU staffing model. The addition of the PEN role in the PACU may help decrease perianesthesia failure-to-rescue events, encourage collaborative medical event management, and help staff feel more supported. Evaluation by PEN in the PACU decreased the number of rapid response calls on those same patients admitted to the ward for the first 24 hours after the end of anesthesia.