This general audit on staffing the Post Anaesthetic Care Unit (PACU) was commissioned as a result of discussions around staffing held at two British Anaesthetic and Recovery Nurses Association (BARNA) Talks seminars in November 2009 and March 2010. Audit forms were sent to all BARNA members and made available on its website. One hundred audit forms were returned. The audit results clearly indicated that many problems exist in ensuring safe and appropriate staffing in the PACU at all times. The audit results highlighted the need for BARNA to take a lead in promoting information to inform PACU staff planning and to make this information freely available on its website.

A new service was implemented as a pilot scheme. It utilised Recovery Nurses as transfer Nurses, to return patients to a ward following surgery, thereby reducing patient wait times on hospital trolleys. Patient wait times, on hospital trolleys raised concerns for tissue viability, which had implications for increased in-patient length of stay and costs. An impact assessment of the new service was undertaken to identify and analyse the direct and indirect impacts of the pilot scheme.

A systematic review of Government literature over the preceding two decades highlighted patient experience and pressure ulcer reduction was high on their agenda. There was little published literature around overlays and mattress types for hospital trolleys as preventative measures for pressure ulcers, yet pressure area care can be traced back to 1962.

The lack of nationally agreed guidelines to assess the suitability of the standard hospital trolley still remains a problem, and research was not able to provide clear, discrete answers to clinicians, to aid decision making. Hospital trolley mattresses need to have the same value placed upon them as bed mattresses and pressure-relieving devices and more risk management strategies need to be utilised for pressure sore prevention, where trolleys are concerned.

Within this article the author critically reviews the theories surrounding clinical decision making and judgement while discussing a clinical incident, and his experiences of decision making within his own practice setting. Exploring the works of Elstein and Schwarz, Benner, Hammond and Hamm, the author discusses how aspects from each of their theories relate to his practice and clinical reasoning before concluding on the clinical decision-making process and factors that can influence their successful application.