Perioperative RNs Research Articles

Clinical Issues - September 2024.

Selecting nonsterile sharps disposal containers Key words: sharps safety, Occupational Safety and Health Administration (OSHA), bloodborne pathogens, occupational exposure, disposal container. Life support certification requirements for perioperative RNs Key words: basic life support, advanced cardiac life support (ACLS), cardiopulmonary resuscitation, certification, training. Using crisis checklists in the perioperative environment Key words: emergency manuals, cognitive aids, clinical emergencies, crew resource management, crisis checklist. Walking patients to the OR Key words: fall prevention, fall risk, mobility assessment, safe patient handling and mobility (SPHM), ambulate.

The Lived Experience of Ambulatory and Perioperative RNs Displaced During the COVID-19 Pandemic: A Phenomenological Study.

During the patient surge associated with the onset of the COVID-19 pandemic in the spring of 2020, perioperative and ambulatory RNs at an acute-care specialty orthopedic hospital were redeployed to medical-surgical inpatient nursing units to care for patients with the disease. The purpose of this phenomenological study was to describe perioperative and ambulatory RNs' experiences during the redeployment. We used purposeful sampling to obtain representatives who worked routinely in perioperative (including postanesthesia care) and ambulatory settings before redeployment. Data saturation was reached after eight in-depth interviews that yielded rich descriptions of the nurses' experiences. Most participants indicated that the fundamental structure of the experience involved being "thrown into a war without weapons" and needing to find ways to fight. The results of this study provide a unique contribution to nursing literature and may assist nurses and leaders in the future.

Interprofessional Collaboration in the OR: AQualitative Study of Nurses' Perspectives.

Interprofessional collaboration (IPC) in the OR enhances safe and effective patient care. The aim of this qualitative study was to explore perioperative nurses' perspectives on their contributions to IPC. We conducted a secondary analysis of 19 semistructured interviews with perioperative RNs and completed inductive thematic analysis with subsequent categorization of the themes into the Interprofessional Education for Collaborative Patient-Centred Practice Framework. Nurses expressed the importance of being heard through effective communication, feeling confident in their role, being aware of interdependent roles, and sharing a common understanding. From nurses' perspectives, use of structured processes enabled organization of interdisciplinary patient care. Nurses showed leadership skills when they anticipated the needs of the team and recognized they needed support to develop these skills. They contributed to IPC through their shared understanding of common goals, leadership skills in the OR, and active involvement in delivering structured processes.

Perioperative Nurse Recruitment: An OR Placement Program for Fourth-Year Nursing Students in Ontario.

Nursing associations have predicted a worldwide shortage of perioperative RNs as more nurses reach retirement age. Additionally, the lack of perioperative exposure during undergraduate nursing programs is contributing to the failure to attract recently graduated nurses to this field. In 2019, multiple hospital sites within the St. Lawrence College network in Ontario, Canada, expressed difficulty recruiting perioperative RNs and expressed an interest in collaborating with the college to increase exposure to the perioperative specialty and recruit students to their ORs after graduation. The college has run a successful preceptor-supported OR placement program for fourth-year baccalaureate nursing students since 2019. Eleven out of thirteen students were hired into the OR after their 2020-2021 placement program. This article outlines the steps taken to initiate this program as well as results of a formal program evaluation conducted in 2021, including detailed feedback from participating students, preceptors, and leaders at the involved hospitals.

Guidelines in Practice: Preoperative Patient Skin Antisepsis.

Surgical site infections (SSIs) frequently involve resident bacteria (eg, Staphylococcus aureus) on the patient's skin. Strategies to help prevent SSIs include removing soil and transient microorganisms from the skin before surgery. Preoperative decolonization, preoperative bathing, and application of an effective skin antiseptic at the surgical site are components of a multimodal approach to reducing microorganisms to subpathogenic levels. As members of an interdisciplinary team, perioperative RNs are essential in the development and implementation of SSI prevention bundles to promote patient safety. This article discusses recommendations from the AORN "Guideline for preoperative patient skin antisepsis" for decolonization protocols, preoperative bathing, and selection of surgical site antiseptics. A scenario describes the process a facility team uses to determine components of an SSI prevention bundle after recognizing an increase in infections from multidrug-resistant organisms.

Guidelines in Practice: Electrosurgical Safety.

Surgeons routinely use electrosurgical devices to cut and coagulate tissue during surgical procedures. However, hazards associated with electrosurgery (eg, burns, electrical shock, fire) can place patients or personnel at risk. Perioperative nurses should standardize processes, preoperatively assess the risks for electrosurgical injuries, and participate in education activities on electrosurgical safety to help prevent injuries from occurring. The AORN "Guideline for electrosurgical safety" provides guidance to perioperative personnel for safe use of electrosurgical units, electrocautery devices, and argon-enhanced coagulators. This article discusses prevention of electrosurgical unit injuries, including those that can be caused by electrosurgical accessories. A scenario describes how a team investigating two incidents related to use of electrosurgery uses an assessment tool to identify risks for injury and includes a report of these risks in the surgical briefing. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures for electrosurgical safety.

Guidelines in Practice: Environmental Cleaning.

All perioperative personnel are responsible for providing a clean environment for patients undergoing operative or other invasive procedures. A contaminated environment can contribute to the incidence of surgical site infections when a patient's skin contacts a contaminated surface or personnel touch a contaminated surface and then transmit microbes to the patient. Airborne contaminants may settle on the sterile field or in the surgical wound. The AORN "Guideline for environmental cleaning" provides guidance on cleaning product selection, cleaning procedures, personnel education, competency verification, and monitoring cleanliness through performance improvement processes. This article discusses guideline recommendations for cleaning procedures and cleaning of operating and procedure rooms. A scenario describes how an ambulatory surgery center team identifies gaps in cleaning processes and modifies the cleaning checklist to improve these processes. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures for environmental cleaning.

Guidelines in Practice: Autologous Tissue Management.

During a surgical procedure, the surgeon may remove tissue to be preserved and stored for replantation or autotransplantation on or in the same individual during a subsequent procedure. The AORN "Guideline for autologous tissue management" provides guidance to perioperative personnel for preserving and handling autologous tissue (eg, cranial bone flaps, parathyroid tissue, skin, vessels) that will be replanted or autotransplanted in the same facility in which the tissue was surgically removed. This article discusses guideline recommendations on packaging, labeling, storing, and disposing of autologous tissue. A scenario describes how an interdisciplinary team uses the AORN guideline and Guideline Essentials to identify recommendations and tools to incorporate into their policy and procedures after their facility receives a citation during a regulatory site visit. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures on autologous tissue management.

Guidelines in Practice: Sharps Safety

Perioperative personnel are at risk for sharps injuries when using devices with sharp points and edges and therefore are at risk for infection from exposure to blood and other potentially infectious body fluids. The Occupational Safety and Health Administration bloodborne pathogens standard is the regulatory document that health care employers must follow to protect personnel who are at risk for sharps injuries. The AORN "Guideline for sharps safety" provides guidance to perioperative personnel for identifying sharps hazards and implementing best practices to prevent injuries. This article discusses the guideline recommendations for developing and implementing work practice controls and administrative controls for handling sharps. A scenario describes an interdisciplinary team's efforts to decrease specific sharps injuries and develop policies and procedures based on the identified risks and practice changes. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures for sharps safety.

A Five-Step Evidence-Based Practice Primer for Perioperative RNs.

Perioperative nurses work in a complex health care setting and are well-positioned to mitigate unexpected events and promote optimal patient outcomes. Thus, perioperative nurses must adapt to rapid advances in technology, treatments, and scientific discoveries to maintain clinical competence and provide care that reflects current evidence. Evidence-based practice (EBP) is a standard of professional nursing performance and an expectation of professional nursing practice. Because EBP is foundational to health care quality and safety, perioperative nurses must understand the concepts of EBP and have the capacity to apply evidence to their clinical practice. However, some perioperative nurses struggle with EBP concepts and find it difficult to access, appraise, and apply evidence. In this article, we describe the five-step EBP process and provide valuable insights into EBP for perioperative RNs.

Guidelines in Practice: Sterilization Packaging Systems.

Sterile processing personnel use sterilization packaging systems to sterilize reusable medical devices and protect them from contamination until perioperative nurses deliver the items to the sterile field. The AORN "Guideline for sterilization packaging systems" provides guidance for evaluating and selecting appropriate packaging systems based on compatibility with the items to be sterilized and the sterilization method, preparing items for sterilization, and verifying achievement of sterilization parameters. This article discusses the guideline recommendations for selecting and using packaging systems and educating personnel about their use. A scenario provides an example in which a perioperative educator uses an audit tool to determine sterile processing and perioperative team members' educational needs related to packaging systems and to evaluate the outcomes after an education session and competency verification activities. Perioperative RNs should review the entire guideline for additional information and guidance when creating and updating policies and procedures on use of sterilization packaging systems.

Guidelines in Practice: Hypothermia Prevention.

All patients are at risk for unplanned hypothermia in the perioperative practice setting. Adverse outcomes attributed to hypothermia include myocardial events, surgical site infections, poor wound healing, increased blood loss, and prolonged postanesthesia care unit stays. The AORN "Guideline for prevention of hypothermia" includes recommendations for measuring the patient's body temperature, selecting methods for prevention of unplanned hypothermia, and implementing the selected insulation and warming interventions. This article discusses guideline recommendations related to using a consistent temperature measurement method through all phases of perioperative care, assessing risk for hypothermia in all patients, and prewarming perioperative patients. A scenario provides an example in which an interdisciplinary facility team uses a gap analysis and a risk assessment to determine the process for implementing recommendations from this guideline. Perioperative RNs should review the entire guideline for additional information and for guidance when creating and updating policies and procedures related to unplanned hypothermia.

Guideline Implementation: Transmission-Based Precautions.

Transmission of an infectious agent requires a source of infection, a mode of transmission, and a vulnerable host. The most important interventions for preventing infection transmission are hand hygiene and use of standard precautions for all patients. Other precautions are based on how an organism is transmitted; these include contact, airborne, and droplet precautions. The cornerstone of transmission-based precautions is appropriate use of personal protective equipment to protect personnel and patients from infection. This article discusses key takeaways from the "AORN guideline for transmission-based precautions," including using standard precautions; wearing personal protective equipment when exposure to blood, body fluids, or other potentially infectious materials is anticipated; and using contact precautions during care of patients known or suspected to be infected or colonized with pathogens transmitted by direct or indirect contact. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Guideline Implementation: Sterile Technique

Establishing and maintaining a sterile field to help prevent surgical site infections requires specific knowledge and skills and is among the most important responsibilities of the perioperative RN. Perioperative RNs should remain vigilant in monitoring the sterile field, communicate when a break in sterile technique occurs, and collaborate with other surgical team members to correct the break in technique. The AORN "Guideline for sterile technique" provides guidance to perioperative personnel on the principles and processes of sterile technique. This article elaborates on key takeaways from the guideline, including using sterile technique when donning sterile gowns and gloves, delivering sterile items to the sterile field, using drapes to establish a sterile field, and maintaining the sterile field. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Guideline Implementation: A Safe Environment of Care.

The OR can be a hazardous environment for both patients and personnel. Low lighting, fluid on the floor, combustible and noxious chemicals, multiple pieces of equipment with cords, the fast pace, and numerous distractions are only some of the factors that can lead to an accident or injury. The AORN "Guideline for a safe environment of care" provides guidance to perioperative personnel on identifying hazards and implementing processes to mitigate risks in the perioperative setting. This article elaborates on key takeaways from the guideline, including precautions to reduce the risk of OR fires; occupational injuries associated with slips, trips, and falls; and handling, storing, and using hazardous chemicals. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Guideline Implementation: Sterilization.

Ensuring that reusable surgical instruments and medical devices have been sterilized is an important factor in preventing surgical site infections. The sterilization method for a particular device is based on the device design, material, packaging, compatibility with the sterilant, load limitations, and safety requirements. Perioperative team members must review the manufacturer's instructions for cleaning, packaging, and sterilizing the device to determine the correct sterilization process. The AORN "Guideline for sterilization" provides guidance for processing reusable medical devices for use in perioperative and procedural settings. This article elaborates on key takeaways from the guideline, including processing a device based on the intended use of the item, protecting sterile items during transport, reprocessing by immediate-use steam sterilization when certain conditions can be met, and educating personnel who perform sterile processing activities. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Guideline Implementation: Safe Patient Handling and Movement: 1.8 www.aornjournal.org/content/cme.

Physical stressors that occur with patient and equipment handling in the OR (eg, moving or lifting patients, carrying heavy instrument sets, prolonged standing) can contribute to musculoskeletal disorders for perioperative personnel. In addition to increasing patient safety, safe patient handling and movement (SPHM) programs have been shown to reduce the risk and severity of injuries, workers' compensation costs, and personnel fatigue and to increase health care workers' morale and quality of life. The AORN "Guideline for safe patient handling and movement" provides guidance for implementing an SPHM program. This article discusses key takeaways from the guideline, including forming an interdisciplinary team to oversee the SPHM program, selecting safe patient handling technologies and equipment, and assessing the unique needs of each patient to develop an individualized plan for SPHM. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Single-Event Multilevel Surgery to Correct Movement Disorders in Children with Cerebral Palsy.

Cerebral palsy (CP) is a common motor disability that may be congenital or acquired. Children with CP often have gait, balance, and posture abnormalities, some of which may be severe enough to interfere with safe ambulation or other activities of daily living. Nonsurgical and surgical interventions are part of the management plan for children with CP. Historically, surgeons addressed gait deviations individually and sequentially with single-level surgeries. However, computerized motion analysis and advances in orthopedic internal fixation devices have improved the outcomes for patients undergoing single-event multilevel surgery. This article provides perioperative RNs with a basic understanding of movement disorders that can be corrected with single-event multilevel surgery, the role of computerized motion analysis in making treatment decisions for ambulatory pediatric orthopedic patients with CP, and various treatment options for the movement disorders of children with CP.

Back to Basics: Unplanned Patient Hypothermia

Unplanned perioperative hypothermia is a common occurrence and can negatively affect a patient's postoperative course. Perioperative nurses are responsible for identifying patients at risk for hypothermia and working with the entire surgical team to prevent this complication from occurring. Multiple interventions can be implemented to address hypothermia, including active or passive warming and warm IV and irrigation fluids. This Back to Basics article addresses patient assessment concerns, identifies a variety of evidence-based interventions that can prevent or mitigate perioperative patient temperature changes, and provides basic steps for perioperative RNs to follow to help prevent perioperative hypothermia in their patients.

Guideline Implementation: Manual Chemical High-Level Disinfection: 1.5 www.aornjournal.org/content/cme.

The Spaulding system recommends sterilization or, at minimum, high-level disinfection for semicritical medical items (ie, items that come into contact with mucous membranes or nonintact skin). High-level disinfection deactivates all types of microorganisms except bacterial spores and prions. If high-level disinfection is not performed correctly, however, contaminated medical or surgical devices could transmit pathogens to patients. Reusable semicritical items may be processed using manual methods when manual chemical high-level disinfection is the only processing method recommended by the manufacturer. The AORN "Guideline for manual chemical high-level disinfection" provides guidance to health care personnel for performing effective manual chemical high-level disinfection and preventing injury associated with the use of high-level disinfectant chemicals. This article focuses on key points of the guideline that address preparation of items for high-level disinfection, use of high-level disinfectants, health care personnel safety, and documentation. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.