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A comprehensive report about the patient’s pain and measures that have been taken to get it under control in addition to the customary information about the patient’s surgical procedure and general condition is essential to communicate when care is transferred from one nurse to another (Jarzyna et al., 2011). It is important to include the patient’s individual and iatrogenic risk factors for respiratory depression (Box 5-2). For example, high opioid doses intraoperatively or in the PACU, a history of snoring or apnea, and prolonged surgery are significant risk factors and should be included in the report so that the nurse on the clinical unit can prepare for appropriate close monitoring of the patient (Jarzyna et al., 2011). It may be necessary, in some cases, to arrange transfer to a unit that can provide the needed monitoring if it is discovered that the intended clinical unit is unable to provide it.

Complete pain control on admission to the clinical unit for all patients is an unrealistic and dangerous expectation. All team members must appreciate that it may take time after transfer to the clinical unit to establish optimal pain control in patients who had severe pain on admission to the PACU; the primary objective is to provide both effective and safe analgesia (Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011). The PACU nurse should inform the nurse assuming care of the patient on the clinical unit about the patient’s pain rating goal, how close the patient is to achieving it, what has been done thus far to achieve it (e.g., analgesics, doses, and time of administration), and how well the patient has tolerated analgesic administration (adverse effects).

Box 5-2 Risk Factors for Opioid-Induced Respiratory Depression