Handover to recovery

Why recovery handover matters

• Recovery (PACU) is a high-risk transition point: residual anaesthetic drugs, airway risk, bleeding, and pain can change quickly.
• A clear, consistent handover reduces missed information and delays in treating pain, nausea, hypotension, or airway obstruction.
• Aim: the recovery nurse knows what happened, what to watch for, and what you want done next.

When and how to hand over (practical basics)

• Do the handover face-to-face at the bedside, with the patient present, once monitors are on and you have initial observations.
• Use a structured format (e.g., SBAR: Situation, Background, Assessment, Recommendation) to avoid omissions.
• Minimise distractions: pause non-urgent tasks, ensure the receiver is ready, and confirm key points were understood.
• If you must leave early, ensure another anaesthetist takes over responsibility and completes the handover.

Start with immediate safety: ABC and monitoring

• Airway: what airway device is in/out, any difficulty, current airway concerns (snoring/obstruction, swelling, blood).
• Breathing: oxygen delivery method and target saturations; ventilation concerns (COPD, OSA, obesity, residual paralysis).
• Circulation: blood pressure/heart rate trends, rhythm issues, bleeding risk, IV access and fluids running.
• Disability: level of consciousness, pain score, nausea, temperature, blood glucose if relevant.
• Exposure: drains, dressings, positioning issues, pressure areas, tourniquet time if relevant.

Minimum dataset to include (what recovery needs every time)

• Patient identifiers: name, DOB/NHS number (or local identifier), allergies, weight if relevant to dosing.
• Procedure and side/site: what operation was done and any intra-op events that change risk.
• Anaesthetic technique: GA/neuraxial/regional/sedation; airway type (ETT/LMA), size, and whether it was easy or difficult.
• Analgesia given: paracetamol/NSAID/opioids (drug + dose + time), local infiltration, blocks (type, side, catheter).
• Antiemetics given: drug + dose; history of PONV/motion sickness if relevant.
• Antibiotics and other key drugs: timing, tranexamic acid, steroids, anticoagulants if given/withheld.
• Fluids and blood: total IV fluids, estimated blood loss, urine output if measured, transfusions and current Hb if known.
• Lines and devices: cannula size/site, arterial line, central line, epidural, nerve catheter, drains, urinary catheter.
• Current status: latest observations, oxygen requirement, pain/nausea level, temperature, any concerns right now.
• Plan: what you want next (e.g., analgesia plan, BP targets, oxygen/CPAP, blood tests, escalation triggers).

Airway and respiratory specifics (common first-time scenarios)

• Difficult airway: clearly state what made it difficult, what worked, and what to do if obstruction occurs (e.g., jaw thrust, OPA/NPA, call anaesthetist early).
• OSA/obesity: consider higher risk of obstruction and hypoventilation; specify oxygen plan and whether CPAP should be used.
• Residual neuromuscular block: confirm reversal given and clinical recovery; warn recovery to watch for shallow breathing, desaturation, weak cough.
• Aspiration risk or regurgitation event: state if occurred/suspected, what was done, and what monitoring is needed (oxygen, CXR only if clinically indicated).

Pain handover (make it actionable)

• Give a simple stepwise plan: what has been given, what can be repeated, and what to avoid (e.g., morphine sensitivity, renal impairment and NSAIDs).
• Regional/neuraxial: document block type, side, time performed, expected duration, and any complications (e.g., paraesthesia, vascular puncture).
• Epidural/spinal: include drug concentration/rate/bolus settings, sensory level if known, and hypotension/urinary retention risk.
• If pain is expected to be severe, pre-empt: prescribe rescue analgesia and consider early review rather than repeated small doses without a plan.

Nausea, delirium, and sedation

• PONV risk: mention history and what prophylaxis was given; provide a clear rescue antiemetic plan (different class if possible).
• Sedation: state any long-acting opioids/benzodiazepines given; warn about delayed respiratory depression (especially with OSA).
• Agitation/delirium: mention if patient was confused pre-op, alcohol withdrawal risk, or emergence delirium; suggest calm environment and early review if unsafe.

Bleeding, fluids, and haemodynamics

• State estimated blood loss and whether bleeding is ongoing/expected (e.g., ENT, urology, obstetrics, major orthopaedics).
• Give haemodynamic trends: “needed metaraminol boluses” or “stable throughout” is more useful than a single BP number.
• Specify targets: e.g., “keep SBP 100–140” or “MAP >65” (tailor to patient: head injury, vascular surgery, chronic hypertension).
• If significant blood loss: say what blood products were given, what is available, and whether repeat Hb/coagulation is needed.

Regional blocks and local anaesthetic safety

• State total local anaesthetic dose and site(s), especially if multiple blocks/infiltration were used.
• Warn about local anaesthetic systemic toxicity (LAST): early signs include tinnitus, metallic taste, agitation; severe signs include seizures/arrhythmias.
• If a catheter is in place: label it, document infusion details, and clarify who manages it (acute pain team/anaesthetics).

Escalation and responsibility

• Make it clear who to call and when: anaesthetist, surgeon, acute pain team, ICU outreach.
• Give explicit triggers: increasing oxygen requirement, repeated airway obstruction, persistent hypotension, uncontrolled pain, excessive bleeding, reduced consciousness.
• Do not leave recovery until the patient is stable and the recovery nurse is happy with the plan (or you have escalated appropriately).