To the Editor:

Please let us refocus not so much on the issue of a litigious society, but rather on the safety of patient care when talking about whether PACU nurses should be extubating patients.

It is generally not within the scope of professional practice for registered nurses to intubate patients unless they are certified registered nurse anesthetists. Thus, the question to be asked is whether the nurse who extubate a patient is prepared to deal with any of the complications (one of which is reintubation) which may arise. If the nurse cannot handle the complications, the nurse should not extubate the patient.

It would be appropriate to first check with your State Board of Nursing to determine their position on the issue. If the Board determines registered nurses may extubate patients with appropriate training, then an extensive and intensive training program could be offered to PACU nurses. This program should contain not only the appropriate considerations for extubation, but also considerations for re-intubations, and specifically those frequent complications following extubation after surgery. It should be conducted by an anesthesiologist or CRNA, and be approved by the Medical Staff. You would want to be certain there is mandatory annual recertification, and each nurse who is credentialed to do extubations has an adequate number of re-intubation procedures throughout the yew to maintain competency. Even if the nurses are certified to extubate patients, there should be an anesthesiologist or CRNA available to assist in the event complications arise.

It is my advice to nurses in my facility: “Do not extubate a patient if you cannot re-intubate, or if you cannot handle every complication which may arise following extubation of a post-anesthesia surgical patient”.

I would question the quality of mean anesthesia care if patients are frequently arriving in the PACU intubated. This is an anesthesia issue, and should be dealt with by your department of anesthesia.

As a risk manager in a large health care system, I certainly am interested in decreaseing our exposure to liability, and am aware of an increasing litigiousness of our society. The most important aspect of good risk management is a firm, steady focus on quality patient cam Competent, trained, CARING people am the best risk management tools we have

E. Lin Tuthill, B.S.N., J.D., Director, Corporate Risk Management Counsel, Presbyterian Healthcare System, Dallas, TX.