DASAIM’S rekommandation for udskrivningskriterier fra anæstesiologisk observationsafsnit.
Introduktion:
I denne revision af rekommandationen er det hensigten at beskrive de kriterier, DASAIM anser for at skulle være opfyldt før en overdragelse fra anæstesiologisk varetægt til stamafdeling eller hjemmet.
Rekommandationen gælder patienter > 14 år der har gennemgået anæstesi til kirurgi, diagnostik eller behandlingsprocedure.
Anæstesiudvalget har valgt at bibeholde 4 punktsskalaen som scoringssystem, da denne er solidt implementeret landet over, til trods for at man i andre lande hyppigst anvender den modificerede Aldrete score, som er en 3 punkts skala.
Timediurese og temperatur er ikke længere en fast del af scoringssystemet, men vil fortsat indgå i den samlede vurdering af patienten.
I DAD4 er selv udskrivningsscoresystemet udgået som indrapporteringskrav. Der er dog fortsat krav om smerte- og kvalmescoring.
Der er kriterier for, hvornår sygeplejepersonale kan overdrage patienterne uden først at have kontaktet anæstesilæge, og hvornår anæstesilæge skal vurdere om, en overdragelse kan finde sted.
Generelle regler:
Alle patienter vurderes ved ankomst til observationsafsnittet og inden udskrivelse til stamafdeling eller hjemmet. Idet patientkategorier udviser stor variation i kompleksitet, og de aftagende afsnit har varierende observationskapacitet, kan det være nødvendigt at udfærdige lokale målrettede aftaler om udskrivelseskriterier med specificeret ansvarsfordeling.
Før udskrivelse til hjemmet er det vigtigt, at patienten er velinformeret om det kirurgiske indgreb, det videre forløb, samt hvordan patienten skal reagere hvis der tilstøder komplikationer.
Udskrivelse af sygeplejerske uden forudgående kontakt til anæstesilæge, hvis følgende kriterier er opfyldt (medmindre der er lavet lokal aftale):
- Patienter > 14 år
- ASA < 3 eller ASA ≤ 3, hvis patienten har opnået sin habituelle tilstand
- Ukompliceret kirurgisk indgreb/behandling eller diagnostisk procedure
- Ukompliceret anæstesiologisk og observationsforløb • Blodtab < 500 ml
- Alle delscores ≤ 1 og en summeret score ≤ 4
- Ved patienter med epidural – eller anden form for smertekateter skal der foreligge plan for smertebehandling ordineret af læge.
Alle andre patienter udskrives af anæstesilæge.
Scoringssystem
Udskrivelse af sygeplejerske: Alle delscores ≤ 1 og en summeret score ≤ 4 (se punkter ovenfor)
En Numerisk rangskala 0-10 kan også anvendes:
Udtalte : NRS ≥ 7
Moderate: 3 < NRS < 7
Lette : 0 < NRS ≤ 3
Ingen : NRS = 0
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