Gather the necessary equipment at the patient’s bedside.

Perform hand hygiene and put on gloves.¹,²,³

Receive hand-off communication about the procedure and the patient’s condition from the perioperative nurse.⁴ This record should include a summary of operative procedures and pertinent findings; type of anesthesia; vital signs (preoperative, intraoperative, and postoperative); medical history; medication history, including preoperative, intraoperative, and postoperative medications; fluid therapy, including estimated blood loss, type and number of drains, catheters, and amount and characteristics of drainage; and notes on the condition of the surgical wound. For example, if the patient had vascular surgery, knowing the location and duration of blood vessel clamping can prevent postoperative complications.⁴,⁵

Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.⁶

Explain all actions to the patient to decrease anxiety and increase cooperation.

Transfer the patient from the PACU stretcher to the bed, and position him properly. Get a coworker to help, if necessary. When moving the patient, keep transfer movements smooth to minimize pain and postoperative complications and avoid back strain among team members. Use a transfer board as needed.

Raise the bed’s side rails to ensure the patient’s safety.

Monitor the patient’s respiratory status by assessing his airway. Note breathing rate and depth, and auscultate for breath sounds. Provide oxygen to maintain an oxygen saturation of greater than 94%. Simple face masks are generally used until the patient is more awake.⁷

Monitor the patient’s pulse rate. It should be strong and easily palpable. The heart rate should be within 20% of the preoperative heart rate.

Compare postoperative blood pressure to preoperative blood pressure. It should be within 20% of the preoperative level unless the patient suffered a hypotensive episode during surgery.

Elevate the head of the bed, if acceptable from a surgical standpoint, to improve ventilation and to prevent aspiration of secretions.⁵

Assess the patient’s level of consciousness, skin color, and mucous membranes.

Obtain the patient’s core body temperature because anesthesia lowers body temperature. A patient with a temperature lower than 96.8°F (36°C), shivering, or other symptoms of hypothermia should be treated with active rewarming. (See “Hyperthermia-hypothermia blanket use,” page 348.) Hypothermia has deleterious effects on many systems and inhibits the metabolism of inhaled, IV, and regional anesthetics.⁵,⁸