AORN Journal

Collaboration Among Nursing Organizations

Deborah Spratt — 2012-05-01

Colleagues, May is the month in which we celebrate National Nurses' Week. This year, the theme for Nurses' Week, May 6 to 12, is “Nurses Lead From Where We Stand.” As one of its organizational affiliates, AORN stands with the American Nurses Association to recognize and support nursing and the nursing profession as a whole, knowing that this benefits nurses in our perioperative specialty because we are nurses first.

Communication and Safety

Patricia C. Seifert — 2012-05-01

Years ago, if you were asked “What is the most frequent cause of error in the OR?” you would probably have had to think awhile before answering. If I were to ask the same question today, it would likely take you only nanoseconds to come up with the answer, “Poor communication!” “Error” and “communication” have become inextricably linked since The Joint Commission's Sentinel Event Alert that warned health care workers about the association between poor communication and patient injury.

Nurses' responsibility for the future of nursing

David A. Wyatt — 2012-05-01

The Institute of Medicine (IOM) report on The Future of Nursing has now been in publication for a full year. This report is a landmark for our profession in its focus and its call to action. The question that I pose for us to consider is “how have we, as an Association and as individual nurses, responded to this call to action?”

Overcoming barriers to implementing recommended practices

Ta Tanisha Eldridge — 2012-05-01

Regarding the article “Implementing AORN recommended practices for prevention of deep vein thrombosis” (November 2011, Vol 94, No 5), I agree that deep vein thrombosis (DVT) and pulmonary embolism are of significant concern in the United States. However, there are barriers to achieving the recommended practices for preventing DVT that need to be addressed in the perioperative setting.

Author response

Sharon A. Van Wicklin — 2012-05-01

Thank you for your thoughtful comments. Having spent more than 36 years in clinical practice, I am aware of and understand the barriers that arise when perioperative nurses and others attempt to implement best practices. The recommended practices implementation guides being published in the AORN Journal are designed to assist perioperative nurses with implementing AORN recommended practices in diverse settings. Your comment regarding the importance of proper and thorough assessment of risk factors and the usefulness of an algorithm or checklist is right on point. I would encourage you to consider developing this kind of assessment tool. As stated in the article, “Many health care organizations are willing to share the documents they have developed and are currently using. Teaching universities (even if not close by) are excellent resources.”(p445)

Continuous application of intermittent pneumatic compression devices

Douglas Burns — 2012-05-01

I was delighted that you chose deep vein thrombosis (DVT) prevention to kick off your new series of recommended practices summaries and implementation guides. I would like to see more information on the need for continuous intervention throughout the hospital stay, particularly as it concerns intermittent pneumatic compression (IPC) devices. I believe that we should strive to maintain continuous application of IPCs from the OR to the postanesthesia care unit (PACU) to the short-term postoperative location, be that the hospital or home. Although we've had access to this technology for decades, a 2010 study by the Agency for Healthcare Research and Quality verified that pulmonary embolism, a consequence of DVT, remains the most common preventable cause of hospital death in the United States. In many hospitals, IPCs are properly placed before induction of anesthesia but, at the end of surgery, the IPCs are discontinued for periods of minutes to hours while the patient makes his or her way through recovery and to the acute care ward.

Author response

Sharon A. Van Wicklin — 2012-05-01

Thank you for your insightful comments regarding the recommended practices implementation article. The hospital patient scenario was included in the article to address the need for nurses to provide patient and family member education as a means to prevent situations wherein IPC devices are disconnected for periods of time. As patient advocates, perioperative RNs should ensure that IPC devices are used continuously from induction until the patient is alert and ambulating.

Educational Opportunities

2012-05-01

Periop 101: A Core Curriculum is a comprehensive, online program for educating new perioperative nurses that provides 40 continuing education contact hours. The curriculum covers 25 pertinent topics and is designed to be integrated with your facility's specific policies and procedures in a clinical practicum and preceptorship. Periop 101 will help you develop confident, better-educated, safety-conscious, entry-level perioperative nurses.

Interruptions and Miscommunications in Surgery: An Observational Study

Brigid M. Gillespie, Wendy Chaboyer, Nicole Fairweather — 2012-05-01

Abstract: In surgery, as much as 30% of procedure-specific information may be lost as a result of miscommunication. We assessed the relationship between interruptions, team familiarity, and miscommunications across a purposive sample of 160 surgical procedures in 10 specialties during a six-month period. Descriptive analysis was used to quantify interruptions in respect to the source (ie, conversational, procedural) and type of miscommunication (ie, audience, purpose, occasion, content, experience). Results revealed an inverse correlation between the length of time that teams had worked together and the number of miscommunications in surgery (τ = −.33, P < .01). There was a positive correlation between the number of intraoperative interruptions and the number of miscommunications (τ = .30, P < .01). These results may help to inform the development of evidence-based interventions designed to mitigate the effects of miscommunications in surgery.

Patient Safety: Break the Silence

Hope L. Johnson, Diane Kimsey — 2012-05-01

Abstract: A culture of patient safety requires commitment and full participation from all staff members. In 2008, results of a culture of patient safety survey conducted in the perioperative division of the Lehigh Valley Health Network in Pennsylvania revealed a lack of patient-centered focus, teamwork, and positive communication. As a result, perioperative leaders assembled a multidisciplinary team that designed a safety training program focusing on Crew Resource Management, TeamSTEPPS, and communication techniques. The team used video vignettes and an audience response system to engage learners and promote participation. Topics included using preprocedural briefings and postprocedural debriefings, conflict resolution, and assertiveness techniques. Postcourse evaluations showed that the majority of respondents believed they were better able to question the decisions or actions of someone with more authority. The facility has experienced a marked decrease in the number of incidents requiring a root cause analysis since the program was conducted.

Communication Skills Training to Address Disruptive Physician Behavior

Rebecca Saxton — 2012-05-01

Abstract: Disruptive behavior among health care providers has been linked to negative patient outcomes. High-stress areas, including the perioperative setting, are especially prone to this behavior. The purpose of this study was to develop, implement, and evaluate an educational communication skills intervention aimed at increasing the perceived self-efficacy of perioperative nurses to address disruptive physician behavior. Seventeen perioperative nurses participated in a two-day communication skills program presented by a certified Crucial Conversations trainer. By using paired t test analysis, I found that there was a statistically significant increase in total mean self-efficacy scores immediately after the intervention and four weeks after the intervention. In addition, four weeks after the intervention, participants reported the ability to address disruptive physician behavior 71% of the time. The results of this study suggest that one intervention strategy to address the serious threat of disruptive physician behavior to patient safety is to educate nurses in communication skills.

Implementing AORN Recommended Practices for Laser Safety

Donna Castelluccio — 2012-05-01

Abstract: Lasers used in the OR pose many risks to both patients and personnel. AORN's “Recommended practices for laser safety in perioperative practice settings” identifies the potential hazards associated with laser use, such as eye damage and fire- and smoke-related injuries. The practice recommendations are intended to be used as a guide for establishing best practices in the workplace and to give perioperative nurses strategies for implementing the recommended safety measures. A laser safety program should include measures to control access to laser use areas; protect staff members and patients from exposure to the laser beam; provide staff members and patients with the appropriate safety eyewear for use in the laser use area; and protect staff members and patients from surgical smoke, electrical, and fire hazards. Measures such as using a safety checklist or creating a laser cart can help perioperative nurses successfully incorporate the practice recommendations. Patient scenarios are included as examples of how to use the document in real-life situations.

RP Summary: Recommended Practices for Laser Safety

2012-05-01

PURPOSE: To provide guidance to perioperative personnel in the use and care of laser equipment and to assist practitioners in providing a safe environment for patients and health care workers during the use of laser technology.

Suture Cost Savings in the OR

Susanna S. Walsh — 2012-05-01

Abstract: Materials management personnel at a health care facility in Baltimore, Maryland, were stocking too much suture. They stocked suture requested by surgeons or recommended by suture company representatives, and, because the facility is a teaching institution, they stocked suture requested by residents. No master suture database was available to determine what was needed and what was not. As a result, some suture was rarely used, which cost the facility money and took up inventory space. In response, I created a list of the existing inventory and coordinated with the specialty surgical service coordinators to determine which suture was typically used and in what quantities. I used this information to create a master list, with the goal of eliminating the purchase of suture that was not on this list. I gave the staff members and surgeons two months to assess the list and determine whether the suggested suture was sufficient for their needs. I then asked the materials management personnel to order and maintain suture stock based on the master list. This process took approximately four months and shows how health care providers can take a high-volume item, such as suture, and create cost-saving processes that will serve surgeons' and patients' needs while reducing costs and streamlining stock.

Perioperative Care of the Child With Epilepsy

Rachael Kubiski — 2012-05-01

Epilepsy, a chronic condition in which seizures occur, is a neurological disease that affects approximately two million people in the United States. According to the Centers for Disease Control and Prevention, 140,000 new cases are reported each year, mainly affecting children and older adults. Despite being the third most common neurological diagnosis, epilepsy remains one of the least understood of major chronic conditions. Using data from the Bureau of Labor Statistics, the Centers for Disease Control and Prevention estimates that the direct and indirect cost of epilepsy is $15.5 billion. The cost of epilepsy is also high in terms of disability and human costs, including reproductive issues, comorbid disorders such as cerebral palsy and autism, increased incidence of depression, and discrimination against people with epilepsy because of employers' fears and misinformation about epilepsy.

Finding Voice

Kim Hudek — 2012-05-01

I originally intended to write an article that would provide a review of latex allergies because of an incident that happened at my workplace. However, as I started reviewing the literature about latex allergies and thought more about what had happened, I began to wonder whether the incident was less about a lack of professional knowledge or competence than it was about nurses doubting their levels of knowledge or competence. Nurses work in environments in which the surgeon or physician is often seen as the final authority. Although the surgeon or physician has the ultimate responsibility for the patient's care, nurses are responsible for the care they deliver. This is especially true during perioperative care because the patient and his or her family members are unable to advocate for the patient. The perioperative nurse must advocate for the patient by providing care that integrates the patient's psychological, social, physical, and spiritual needs. The nurse then must be the patient's voice.

Near Infrared Fluorescent Imaging as a Surgical Navigation Tool: The Time Has Come

Ramon Berguer — 2012-05-01

The dramatic technological advances of the past century have demonstrated that human sensory capabilities go only so far and must be supplemented by additional types of sensory feedback to ensure efficient, accurate, and safe execution of control tasks. For example, visual navigation aids are commonplace in critical human control tasks, such as piloting aircraft. In the field of medicine, many of the most important diagnostic and therapeutic advances during the past 50 years have been in the area of imaging. Today, computed tomography scanning, magnetic resonance imaging, positron emission tomography scanning, and ultrasonography comprise the leading medical imaging technologies. Their introduction into routine clinical practice has led to more accurate and timely diagnoses of illness and injury, as well as precise image-guided therapeutic interventions that have vastly improved the quality of care for patients.

Clinical Issues—May 2012

Joan C. Blanchard, Bonnie Denholm — 2012-05-01

This Month: Reuse of single-use devices Key words: single-use devices, resterilization, reuse, repurposing of single-use devices. Use of long-sleeved perioperative warm-up jackets Key words: perioperative attire, recommended practices for attire. Requirements for preoperative fasting Key words: NPO, surgical fasting, preoperative fasting. Necessity of medication orders for medications on the sterile field Key words: medication orders, perioperative medication use, ambulatory surgery.

Evidence for Practice

George Allen — 2012-05-01

Surgical site infection (SSI) continues to be a persistent problem despite continual progress in the application of preoperative preventive measures and the use of intraoperative aseptic technique. Performing preoperative skin preparation immediately before the surgical procedure with a solution such as povidone-iodine or chlorhexidine decreases the possibility of a patient acquiring an SSI. Recent evidence suggests that an aqueous chlorhexidine scrub followed by isopropyl alcohol paint may be superior to other antiseptic products in reducing the amount of bacteria on skin.

Management Connections: Implementing strategies for product selection and management

2012-05-01

News In Brief

2012-05-01

Championing sharps safety in the OR

2012-05-01

Simulation in perioperative practice

2012-05-01

Establishing an effective robotic surgical team

2012-05-01

Pocket Syringe Swap

Nancy J. Girard — 2012-05-01

A 58-year-old man underwent an aortoiliac artery bypass graft with an epidural catheter placed for postoperative pain management. During the incision closure, the surgery fellow drew 12 mL of 0.25% bupivacaine into a 12-mL labeled syringe. After injecting 4 mL into the epidural space, the fellow placed the bupivacaine syringe with 8 mL of the remaining medication into the pocket of his scrub suit.

2012-05-01

Editorial Board

2012-05-01

Information for Readers

2012-05-01

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AORN Journal

Collaboration Among Nursing Organizations

Communication and Safety

Nurses' responsibility for the future of nursing

Overcoming barriers to implementing recommended practices

Author response

Continuous application of intermittent pneumatic compression devices

Author response

Educational Opportunities

Interruptions and Miscommunications in Surgery: An Observational Study

Patient Safety: Break the Silence

Communication Skills Training to Address Disruptive Physician Behavior

Implementing AORN Recommended Practices for Laser Safety

RP Summary: Recommended Practices for Laser Safety

Suture Cost Savings in the OR

Perioperative Care of the Child With Epilepsy

Finding Voice

Near Infrared Fluorescent Imaging as a Surgical Navigation Tool: The Time Has Come

Clinical Issues—May 2012

Evidence for Practice

Management Connections: Implementing strategies for product selection and management

News In Brief

Championing sharps safety in the OR

Simulation in perioperative practice

Establishing an effective robotic surgical team

Pocket Syringe Swap

Table of Contents

Editorial Board

Information for Readers