Nursing workload associated with adverse events in the postanesthesia careunit

Background: The authors used a nursing task inventory system to assess nurs ing resources for patients with and without adverse postoperative events in the postanesthesia care unit (PACU). Methods: Over 3 months, 2,031 patients were observed and each task/activity related to direct patient care was recorded and assigned points according to the Project Research in Nursing (PRN) workload system. PRN; values for e ach patient were merged with data from an anesthesia database containing de mographics, anesthesia technique, and postoperative adverse events. Mean an d median PRN points were determined by age, sex, duration of procedure, and mode of anesthesia for patients with and without adverse events in the PAC U, Three theoretical models were developed to determine the effect of diffe ring rates of adverse events on the requirements for nurses in the PACU. Results The median workload (PRN points) per patient mas 31.0 (25th-75th pe rcentile, 25-46). Median workload was 26 points for patients with no postop erative events and 155 for greater than or equal to six adverse events. Wor kload varied by type of postoperative event (e.g,, unanticipated admission to the intensive care unit, median workload = 95; critical respiratory even t = 54; and nausea/vomiting = 33). Monitored anesthesia care or general ane sthesia with spontaneous ventilation used less resources compared with gene ral anesthesia with mechanical ventilation. Modeling various scenarios (con trolling for types of patients) showed that adverse events increased the nu mber of nursing personnel required in the PACU. Conclusions: Nursing care documentation based on requirements for individua l patients demonstrates that the rate of postoperative adverse events affec ts the amount of nursing resources needed in the PACU.