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PACU Discharge & Aldrete Score
Modified Aldrete scoring, Phase I → Phase II criteria, and the discharge checklist you can actually defend.
Free · print it · share it · no gatekeeping
Modified Aldrete (score each 0–2, need ≥9)
- Activity
- 2 = moves 4 extremities · 1 = moves 2 · 0 = moves none
- Respiration
- 2 = breathes deeply, coughs freely · 1 = dyspnea/shallow · 0 = apneic
- Circulation
- 2 = BP ±20% of baseline · 1 = ±20–50% · 0 = ±50%
- Consciousness
- 2 = fully awake · 1 = arousable · 0 = not responding
- O2 saturation
- 2 = >92% on room air · 1 = needs O2 to keep >90% · 0 = <90% with O2
Before you call for transport
- Airway
- Patent, protecting own airway, no stridor, no snoring apnea
- Pain
- Controlled and reassessed after the last dose — not just "medicated"
- PONV
- No active vomiting; antiemetic given and effective
- Bleeding
- Dressing marked and dry, drains documented, no expanding hematoma
- Block
- Level documented if regional/neuraxial; sensory level receding
- Lines/labels
- IV patent, correct fluids, pumps labeled
- Report
- Receiving RN has SBAR + last dose times + orders that are still pending
Do NOT discharge if…
- Respiratory
- RR <8, needs jaw thrust, or repeated desats off stimulation
- Hemodynamics
- New pressor need, unexplained tachycardia, ongoing bleeding
- Neuro
- Not back to baseline mentation, new deficit
- Temp
- <36 °C — warm them first, shivering triples oxygen demand
Baddie pearls 👑
- ✦The opioid you gave 5 minutes before transport peaks in the elevator. Time your last dose.
- ✦OSA + opioids + a quiet floor at 0200 is the classic bad outcome. Extend the stay; document why.
- ✦Score the patient, don't score the clock.
Educational reference only. Always follow your facility's current policies, protocols, and provider orders.
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