🩺 Key Nursing Care Protocol Before Transfer

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1. Immediate Patient Assessment

a.       Check vital signs: Blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature.

b.       Airway patency: Ensure endotracheal tube, tracheostomy, or airway adjuncts are secure.

c.       Level of consciousness: Assess response to verbal/tactile stimuli.

d.       Pain and comfort: Evaluate pain score and administer prescribed analgesics if needed.

2. Stabilization Before Transfer

a.       Hemodynamic stability: Confirm the patient is not in shock or unstable.

b.       Fluid balance: IV lines should be patent, fluids running as prescribed.

c.       Drainage tubes/catheters: Check patency, secure placement, and ensure no leakage.

d.       Dressings: Inspect surgical site dressing for bleeding or soakage.

3. Preparation for Transport

a.       Oxygen support: Provide supplemental oxygen if required.

b.       Monitoring equipment: Attach portable monitors (pulse oximeter, ECG if indicated).

c.       Positioning: Place the patient in supine or lateral position depending on the surgery and airway needs.

d.       Documentation: Record intra-operative events, medications given, fluids, blood loss, and complications.

4. Communication & Handover

a.       Verbal handover: Inform the recovery room nurse about surgery details, anesthesia used, intra-operative events, and current patient status.

b.       Written notes: Provide anesthesia chart, operative notes, and nursing records.

c.       Special instructions: Highlight precautions (e.g., limb positioning, drains, allergies, risk of complications).

5. Safe Transfer

a.       Escort team: At least one nurse and an anesthetist assistant should accompany the sick patient.

b.       Transport trolley: Ensure brakes, side rails, and safety straps are secure.

c.       Continuous monitoring: Observe airway, breathing, and circulation during transfer.

 

✅ Post-Transfer Checklist in Recovery Room

a.       Confirm patient identity and surgical procedure.

b.       Reassess vitals immediately.

c.       Ensure availability of emergency equipment (suction, oxygen, resuscitation kit).

d.       Continue close monitoring until the patient regains consciousness and stabilizes.

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