▪ read the patient’s theatre notes to confirm the surgical procedure that has been carried out and ascertain any instructions from the surgeon or anaesthetist, e.g. the positioning of the patient or any oxygen therapy required

▪ check that the airway is patent and that the patient is breathing adequately. The patient is usually conscious before leaving the recovery room, but check the level of consciousness on the return to the ward. If he or she is heavily sedated, the tongue may slip back and obstruct the airway. If this happens, first perform the head tilt, chin lift manoeuvre and call for assistance if required. The use of an adjunct airway may be required to secure a patent airway. If the patient is nauseated it may be safer to nurse them in the recovery position if possible.

▪ monitor the respiratory rate and rhythm and look for any signs of breathing distress

▪ monitor oxygen saturation to ensure adequate perfusion. Check the colour of the patient – nail beds, lips for signs of cyanosis

▪ on initial return to the ward 15 minute observations should be performed; this may vary from patient to patient. Record the temperature, pulse (feel the radial pulse for rate and rhythm), blood pressure, and urine output and compare the results with the patient’s preoperative and intraoperative recordings. This will give some indication of the stability of the patient’s condition and allow for prompt recognition of deterioration and improvements in the patient’s condition (NHS Quality Improvement Scotland 2004). The use of a Modified Early Warning Scoring (MEWS) system has been shown to help with prompt recognition of patients at risk of deterioration (Parissopoulos & Kotzabassakis, 2005)

▪ observe the wound, note any staining of the dressing. Observe any drains, e.g. a Redivac free drainage, suction, or corrugated drain, that may be present, monitor patency, amount of drainage and type of fluid to ensure prompt recognition if there are problems such as haemorrhage or blockage

▪ monitor the patient’s pain score (resting and moving) and administer analgesics as required by the patient and as prescribed by the medical staff to relieve pain and anxiety (NHS Quality Improvement Scotland 2004). Check the intraoperative and recovery record for type and last dose of painkiller to ensure over-dosage of analgesia is avoided. Several research studies have demonstrated that patients rate being in pain as the most anxiety-provoking issue when undergoing surgery (Nendick 2000)