Section 250.1320  Postanesthesia Care Units

a)         Provision and use of Phase 1 Postanesthesia Care Unit (Phase 1 PACU)

1)         For the purposes of this Section, Phase 1 of postanesthesia care is the phase immediately following surgery, usually in a recovery room, after which the patient is returned to his or her room.

2)         Postanesthesia care units shall be provided by all hospitals in which surgery is performed.  They shall be in a separate room where patients who have undergone surgical procedures can be immediately observed and receive specialized care by selected and trained personnel and where, when necessary, prompt emergency care can be initiated.

3)         The services of the Phase 1 PACU may be used for postpartum care if the delivery room or place of delivery is in proximity to the Phase 1 PACU.  Only clean (non-infected or non-infectious) postpartum patients may be admitted to the Phase 1 PACU and may, after appropriate observation, be returned to the maternity department.

b)         Personnel

1)         Physician

            A physician shall be responsible for the conduct of the Phase 1 PACU, for the training of Phase 1 PACU personnel, and for the establishment of admission, discharge, and emergency policies and procedures.

2)         Nurse

A)        A registered nurse who has education and experience in Phase 1 postanesthesia care shall supervise all personnel performing nursing service functions.

B)        A registered nurse shall be in attendance at all times when patients are in the Phase 1 PACU.

C)        There shall be sufficient nursing personnel to provide the specialized care required for the postsurgical patient.  It is recommended that a ratio of one nursing personnel to two patients be maintained at all times.

D)        Nursing personnel shall be assigned permanently to the Phase 1 PACU when patients are present.

c)         Practices for operation of the Phase 1 PACU

1)         Only clean surgical cases shall be admitted to the Phase 1 PACU.

2)         Contaminated cases shall be returned to the isolation room or a private room.  Contaminated cases may be admitted to the Phase 1 PACU when a separate isolation facility is within or adjacent to the Phase 1 PACU.

3)         A member of the medical staff shall provide initial orders for the care of each patient upon admission.

4)         A member of the medical staff shall be responsible for the patient's discharge from the Phase 1 PACU.

5)         Anesthetized patients shall be constantly attended.  Side rails shall be attached to movable carts and beds and raised above mattress level when occupied by anesthetized patients. Cribs shall be provided for the anesthetized or postsurgical child.

6)         Written policies and procedures, which shall be reviewed regularly and revised as necessary, shall be established.

7)         A complete orientation program and continuing in-service education program shall be provided for all personnel assigned to the Phase 1 PACU.

8)         Personnel with communicable diseases shall be excluded from the Phase 1 PACU.

9)         Visitors shall be permitted in the Phase 1 PACU if a hospital has adopted a policy, approved through the Governing Board, that allows for visitation in the Phase 1 PACU while the patient is recovering from a surgical procedure. Before allowing individuals to be present in the Phase 1 PACU, the hospital shall have a policy in place that includes at least the following:

A)        Written consent of an adult patient; the parent, guardian, or legal representative of a minor or a mentally disabled adult; or the physician performing the surgery;

B)        Notation in the patient's medical record of the presence of additional visitors in the Phase 1 PACU during recovery of the patient from a surgical procedure;

C)        Application of safeguards against the introduction of infection or other hazards by the visitor, including orientation, education and training of the person, preferably prior to the performance of the procedure but at least prior to visitation; this shall include, at minimum, specifics regarding  recovery, what can be expected, and basic infection control practices expected of the visitor;

D)        Provision of at least one additional staff person in the Phase 1 PACU assigned to oversee, supervise and assist the visitors for the period of time the visitors are present;

E)        Provision of safeguards to ensure the privacy of other patients who may be recovering from surgical procedures, which may include separate rooms or some other type of separation for recovery of patients who would have a visitor present.  Privacy safeguards shall allow Phase 1 PACU staff to provide constant attention to anesthetized patients; and

F)         If, at any point during the recovery of the patient, Phase 1 PACU personnel determine that the visitor poses a threat to the safe, therapeutic recovery of the patient, personnel may require the visitor to leave the Phase 1 PACU.

d)         Drugs, supplies and equipment

            Drugs, supplies and equipment shall be immediately and continually accessible in the Phase 1 PACU, including emergencies.  These shall include cardiac-respiratory monitoring and resuscitation materials.

e)         The Phase 1 PACU shall contain and provide for a drug distribution station, including a secure area, adequate hand-washing facilities, charting and dictating area, soiled utility area with bedpan flushing device, and adequate storage space for supplies and equipment.

(Source:  Amended at 35 Ill. Reg. 4556, effective March 4, 2011)