So far we have made a gentle introduction to the POCU in the context of the principles of perioperative medicine, giving ample consideration to the different perioperative risks patients have and to the distinct levels of care they require. The example of Mrs Evans, as a typical POCU patient, will look familiar and representative enough to pull all these things together into your growing knowledge of postoperative care.

While we do not yet have a specific and completely standardised framework for the training of nurses and Allied Health Professionals in POCU, the important thing to realise is how POCU situates itself at the intersection of several other areas of care, such as the surgical ward, traditional recovery rooms and critical care (ICU/HDU).

Take a look at the image below, intended to represent some of the spheres touching and intersecting with POCU.

(Image credit: J.D WIlliamson and Louise Allen Photography)

Consider the graphic above. Does it match your perspective? What would you add/remove?

And, finally, what do you think this means for the training of the POCU practitioner? Try to list or map out the sort of competencies you think should be required of POCU practitioners before moving on. Write your ideas in the discussion box below and have a look at the ideas of others to compare.

National Training Guidance

Have a look at the image above again. This time we are going to look a little closer at each aspect and identify what National guidance and drivers influence both the need for POCU, and the type of competencies that POCU practitioners need to develop.

Level 1 (Ward care)

The image above shows how Level 1 care is defined according to the National Competency Framework for Registered Practitioners: Level 1.

Recovery Care

The BARNA Standards of Practice define the standards in Education and Training for British Anaesthetic and Recovery Nurses (BARNA). One of their important documents is the immediate post-anaesthesia Recovery 2013 supplement (accessed here).

The Surgical Patient

All patients who have undergone anaesthesia are at risk of postoperative complications including compromise to the airway, breathing and circulation. Therefore, management and transport of patients immediately after anaesthesia can potentially be hazardous. If adequate standards of care are not provided, it is quite likely serious complications can occur. When considering the provision of anaesthesia, the Royal College of Anaesthetists recommends that specific areas should be addressed to reduce these complications and harm, improve outcomes and promote patient wellbeing. These areas include appropriate staffing, equipment, services and facilities; training and education; research and quality improvement; financial management, and appropriate organisation and administration.

Deterioration and emergencies

POCU patients are at varying levels of risk in the postoperative period. When exercising their judgement, all healthcare professionals and practitioners are expected to recognise and respond to deteriorating patients as per guidelines.

Care of the critically ill patients (Level 2&3 care)

The Comprehensive Critical Care 2010 document defines level 2 and 3 patients as above. Closely related to this are the competencies expected of professionals working in ICU – and will of course overlap with those of PACU practitioners.

COVID-19 pandemic

Upskilling to meet critical care demand: The London Transformation and Learning Collaborative (LTLC) Adult Critical Care programme was established in summer 2020 to support the cross-skilling of the London NHS workforce in response to the Coronavirus pandemic and to prepare for the second surge and beyond. These educational resources are extremely valuable.

Optimisation of patient flow

The Royal College of Surgeons has published ‘A New Deal for Surgery’, which advocates for ‘elective recovery programme for both high volume, low complexity procedures (e.g. hip and knee replacements) and specialised procedures (e.g. cancer surgery)’. Across the UK, this means investing in local POCU units to avoid cancellations and to optimise surgical care.

BARNA recognised (even before the COVID-19 pandemic and all the related changes) that working in POCU benefits from specialist training beyond the pre-registration nursing and AHP programmes:

Staff roles and training. (Image credit: BARNA Guidance, source)

The good news for you is that you are already enrolled in a formal Higher-Education Institute programme of study for POCU – we hope you are enjoying it!

Each of the topics we will explore in this programme have been matched against the following guidance and criteria:

1. The National Competency Framework for Registered Nurses in Adult Critical Care – STEP 1. By the Critical Care Networks – National Nurse Leads (CC3N) and the Intensive Care Society (ICS)
2. The London Transformation and Learning Collaborative Adult Critical Care programme. By Health Education England London (NHSHEE_LDN)
3. The National Core Curriculum for Perioperative Nursing. By the Perioperative Care Collaborative (PCC) and the Association for Perioperative Practice (AfPP)

A happy nurse in POCU! (Photo credit: Kate Neil)

Throughout the programme we will suggest that you strengthen your knowledge and skills with self and peer assessment against the STEP 1 competencies.

This programme is not designed to train you to be a Critical Care Nurse/Midwife/AHP, but supports you in building knowledge relevant to working an a higher acuity area with surgical patients.

This may be particularly helpful in securing opportunities for learning, where relevant and agreed with your local trust.