AORN Journal RSS feed: Current Issue. AORN Journal provides registered professional nurses in the OR and related services with information based on scientific fact and principle. Articles cover the nurse's role before, during and after surgery and include patient teaching and preparation, use and care of surgical instruments and supplies, asepsis, sterilization, anesthesia, and related topics. Other areas include education for professional nurses, OR administration and communications. More than 40,000 perioperative nurses, managers and directors read AORN Journal for vital information about their profession. What's more, more than 84% of those readers make product recommendations and influence OR buying decisions...and they learn about OR products and services in the AORN Journal . The AORN Journal is read by more than 99% of the people who receive it, ensuring your advertising will be seen.http://www.aornjournal.org/?rss=yesElsevier Inc.en © 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved. AORN Journal0001-2092923September 2010 © 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.aornjournal.org/article/PIIS0001209210007714/abstract?rss=yes Ninety-nine years ago, in recognition of the 40th anniversary of the Great Chicago Fire of October 9, 1871, the Fire Marshals Association of North America declared that this anniversary “should henceforth be observed not with festivities, but in a way that would keep the public informed about the importance of fire prevention.” In 1920, President Woodrow Wilson proclaimed the first National Fire Prevention Day, and since 1922, Fire Prevention Week has been observed annually during the week in which October 9th occurs.Promoting the Freedom to ProtectCharlotte L. Guglielmi10.1016/j.aorn.2010.07.006AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XPresident's Message251252http://www.aornjournal.org/article/PIIS0001209210006927/abstract?rss=yes I recently read a book titled Out of Your Head and Into Your Heart. Around the same time, I saw an article titled “Preoperative briefing in the operating room: shared cognition, teamwork, and patient safety.” This got me musing about all the information in the perioperative nurse's head and how so much of it is critical to the patient's welfare. Perioperative nurses have stellar technical acumen and caring hearts; that is a given. Still, I can remember a day when I overheard a surgeon say to a perioperative nurse, “Your problem is that you think too much. I don't want you thinking about it. I just want you to give me what I ask for.” I guess he was not too interested in “shared cognition.” I am.Shared Cognition: Reflecting, Considering, DeliberatingJane C. Rothrock10.1016/j.aorn.2010.06.009AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XGuest Editorial253255http://www.aornjournal.org/article/PIIS0001209210007751/abstract?rss=yesThe Nominating and Leadership Development Committee met at AORN Headquarters on July 18 and 19 to select the slate of candidates for the 2011 national ballot. The committee members used the candidates' applications and résumés to obtain information about the candidates' leadership experiences and qualifications. The candidates' election statements, photographs, and biographical information will be published in the January 2011 issue of the AORN Journal.Slate of Candidates and New Voting Procedures10.1016/j.aorn.2010.08.001AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XCongress256257http://www.aornjournal.org/article/PIIS0001209210007738/abstract?rss=yesHolly A. Adams, RN, BSN, CNOR Yellowstone Surgery Center, Billings, MontanaAward-Winning Clinical Improvement/Innovation Posters: Sunday, March 14, to Thursday, March 18, 201010.1016/j.aorn.2010.07.008AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XCongress258258http://www.aornjournal.org/article/PIIS0001209210008082/abstract?rss=yesPeriop 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. For pricing and other information and a demonstration of the course, visit http://www.aorn.org/Periop101.Educational Opportunities10.1016/S0001-2092(10)00808-2AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XEducational Opportunities259263http://www.aornjournal.org/article/PIIS0001209210006617/abstract?rss=yesThere are many reasons why a perioperative nurse would want to conduct a literature search. For example, you may need to find evidence to support a change in practice at your facility, you may need to find references for an article you are writing, or you may just want to seek out information on a topic of interest. Effectively using an Internet search engine (eg, PubMed®, CINAHL®) to perform a literature search is one of the quickest ways to find information.Effectively Conducting an Advanced Literature SearchJennifer M. Brusco10.1016/j.aorn.2010.06.008AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XTapping into Technology264271http://www.aornjournal.org/article/PIIS0001209210005946/abstract?rss=yesAbstract: The high incidence of pressure ulcer development in patients in the perioperative setting indicates the need for improved risk assessment and the use of preventive measures. A clinical nurse specialist used Dever's Epidemiological Model as the theoretical framework to develop a perioperative pressure ulcer risk-assessment scale. The risk factors for the scale were based on findings from a review of the literature. The scale, along with a demographic questionnaire and an evaluation form, was distributed to 12 nurses and three anesthesiologists to obtain expert opinion to further the design of the scale. Twelve participants returned the forms. Only four of the participants had previous experience with a pressure ulcer risk-assessment scale. The results indicated that diabetes should be included as a risk factor category and that preexisting skin ulcerations, breakdowns, and conditions should be addressed within the scale. The participants unanimously agreed that moisture is an important factor to assess. Validation of each risk factor is essential to improve the reliability of the scale before its implementation.The Development of a Pressure Ulcer Risk-Assessment Scale for Perioperative PatientsCassendra A. Munro10.1016/j.aorn.2009.09.035AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XFeatured Articles272287http://www.aornjournal.org/article/PIIS0001209210006599/abstract?rss=yesAbstract: Postoperative surgical site infections (SSIs) are serious health care-associated infections that contribute to higher rates of mortality. Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of SSIs. A quality improvement intervention was developed to identify surgical patients with nasal colonization of MRSA, treat them with mupirocin, and introduce a new preoperative skin antisepsis protocol using 2% chlorhexidine gluconate cloths. The total number of SSIs was reduced by 63%, and MRSA SSIs decreased by 78%. Preoperative MRSA screening and treatment and the preoperative skin antisepsis protocol were smoothly integrated into the facility workflow and well accepted by patients. This intervention saved two community hospitals an estimated $240,000.Reducing Surgical Site Infections by Bundling Multiple Risk Reduction Strategies and Active SurveillanceVirginia Leigh Lipke, Anthony S. Hyott10.1016/j.aorn.2010.01.016AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XFeatured Articles288296http://www.aornjournal.org/article/PIIS0001209210007003/abstract?rss=yesAbstract: The lithotomy position is used daily in the OR to position patients for vaginal, rectal, and urologic procedures. Use of this position requires a careful nursing assessment to ensure that the patient can tolerate having his or her legs placed in the stirrups and to ensure that no pressure points exist for the duration of the surgery. Caring for a patient who is morbidly obese and who requires surgery in the lithotomy position can be especially challenging, and the possibility of injury to the patient or staff members should be considered. A case study involving the care of a patient who weighed almost 600 lb undergoing surgery in the lithotomy position demonstrates ways to provide safe care for this type of challenging patient.Perioperative Care of the Morbidly Obese Patient in the Lithotomy PositionGeraldine Bennicoff10.1016/j.aorn.2010.04.016AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XFeatured Articles297312http://www.aornjournal.org/article/PIIS0001209210006605/abstract?rss=yesAbstract: The pressure on perioperative services to improve quality for health care consumers creates both challenges and opportunities. To make positive changes, many health care organizations contract with Press Ganey (PG), which processes an extensive database of more than 9.5 million surveys annually and provides benchmark reports to same-type organizations. To measure and improve ambulatory surgery patient satisfaction at one health care network in northeastern Pennsylvania, the nursing leaders in the ambulatory surgery center and OR undertook a quality improvement project focused on educating perioperative nurses on the use of PG reports. After we reviewed the PG reports and implemented changes with nursing staff members in perioperative areas, PG patient satisfaction scores improved regarding information about delays (4.1%) and center attractiveness (0.2%).Measuring and Improving Ambulatory Surgery Patients' SatisfactionJanice Farber10.1016/j.aorn.2010.01.017AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XFeatured Articles313321http://www.aornjournal.org/article/PIIS0001209210006630/abstract?rss=yesAbstract: Surgical facilities borrow specialty surgical instrumentation and implants from vendors and other facilities to provide needed inventory to perform scheduled procedures without the burden of purchasing these items. Borrowing has many advantages, including reduced costs and the ability to expand services offered, but borrowed items must be handled and processed in a consistent way to ensure safe patient care. Instruments and implants must be received in time to be properly reprocessed by the borrowing facility. Lack of planning on the part of a hospital or vendor, lack of communication, lack of appropriate policies to guide the processing of items, increasingly complex instrumentation, and increasing workloads are factors that can contribute to lapses in processing requirements and, ultimately, risk to patients and staff members. Improving communication and policies and procedures can improve the quality and safety of loaner instrumentation and implant use.Reducing the Risks Associated With Loaner Instrumentation and ImplantsRose Seavey10.1016/j.aorn.2009.12.032AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XFeatured Articles322334http://www.aornjournal.org/article/PIIS0001209210006976/abstract?rss=yesAbstract: In 2008, a multidisciplinary team at the Medical Center of Georgia, Macon, began a one-year Plan-Do-Study-Act (PDSA) cycle to implement a high-quality pediatric surgery service line. The PDSA team defined goals, objectives, and measurable performance metrics and then reviewed cases and aggregated data monthly to identify and improve clinical, process, instrument, and supply problems as well as patient transfer issues. The PDSA cycle led to improvements in team performance, communication, and patient transfer and decreased the number of problems associated with instruments, supplies, equipment, and surgeon tardiness.Using a Plan-Do-Study-Act Cycle to Introduce a New OR Service LineDon K. Nakayama, Timothy N. Bushey, Irene Hubbard, Dawn Cole, Amanda Brown, Timothy M. Grant, Issam J. Shaker10.1016/j.aorn.2010.01.018AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XFeatured Articles335343http://www.aornjournal.org/article/PIIS0001209210006964/abstract?rss=yesIn health care organizations, teamwork is often regarded as the cornerstone of quality and the foundation for productive, efficient processes and effective outcomes. Certainly, teamwork is vital to ongoing success in the central sterile supply department (CSSD), where ever-evolving technology, increasing caseloads, and near-constant customer demands must be balanced with safe practices. Effective teamwork must not be confined solely within the walls of individual departments, however. Although teamwork within each discipline is crucial, the most effective health care organizations are those that promote interdisciplinary partnerships—from the CSSD, OR, and infection control department to nursing units, the laboratory, labor and delivery, and other areas. Such partnerships might involve regular multidisciplinary meetings, whereby a representative from each department is present to openly express needs, concerns, and challenges as well as stay apprised of unique issues in other departments. This collaborative effort, knowledge sharing, and understanding often leads to effective problem-solving and promotes ongoing quality and safety.Interdisciplinary Teamwork Helps Quality Efforts Reach New HeightsLisa Huber10.1016/j.aorn.2010.06.011AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XIAHCSMM Insider345346http://www.aornjournal.org/article/PIIS0001209210006952/abstract?rss=yesResearch findings and recommendations for evacuating surgical smoke with an appropriate medical device during open and laparoscopic procedures have been widely disseminated. Although the use of smoke evacuation devices in surgical services is embraced by many health care professionals, some resist using these devices for a variety of reasons, including noise, distraction, and the ergonomic difficulties of equipment use. Concerns related to surgical smoke range from its being a nuisance to the potential for health risks from long-term, continuous exposure to carcinogenic substances. Researchers continue to investigate the risks of both direct exposure and long-term exposure to surgical smoke. This article addresses hazards related to surgical smoke exposure as well as risk reduction strategies.Surgical Smoke Evacuation During Laparoscopic SurgeryDonna S. Watson10.1016/j.aorn.2010.06.010AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XPatient Safety First347350http://www.aornjournal.org/article/PIIS0001209210006940/abstract?rss=yesDo surgical sealants prevent or reduce postoperative air leaks after pulmonary resection for lung cancer? More than 200,000 patients with lung cancer undergo lung resection annually. After removal of a lobe of the lung, the surgeon must reattach portions of the trachea or bronchus to another portion of the trachea or bronchus. The usual practice is to suture or staple the portions together. Air leaks are a common complication of this reattachment after lung resection, and they can lead to negative outcomes, including empyema, a longer period of time before the chest tube can be removed, and a lengthened hospital stay. Five percent of patients experience air leaks after the surgery. A possible option to prevent air leaks would be to use a sealant in addition to sutures or staples.Surgical Sealant for Preventing Air Leaks After Pulmonary Resections in Patients With Lung CancerWilliam H. Anger10.1016/j.aorn.2010.05.026AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XCochrane Nursing Corner351352http://www.aornjournal.org/article/PIIS0001209210006629/abstract?rss=yesThis Month: Safe perioperative use of glutaraldehydeKey words: high-level disinfection, glutaraldehyde, disinfectant, glutaraldehyde-based products, adverse effects, low-level disinfection, chemical disinfection, liquid sterilant.Safe patient handling and movement in the perioperative settingKey words: ergonomics, prepping, patient handling.Thermal burns during phacoemulsificationKey words: corneal burns, thermal burns, phacoemulsification, cataract surgery.Wearing surgical masks while administering a spinal anestheticKey words: surgical mask, spinal anesthetic, anesthesia care provider, aseptic technique.Clinical Issues—September 2010Mary Ogg10.1016/j.aorn.2010.07.001AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XClinical Issues353363http://www.aornjournal.org/article/PIIS0001209210007696/abstract?rss=yesBispectral index (BIS) is used to measure the patient's level of consciousness under general anesthesia to prevent surgical awareness. Several factors have been found to alter the BIS reading without affecting the depth of anesthesia, however. Anesthesiologists at a university hospital in Saudi Arabia noticed a change in BIS readings that appeared to be associated with changes in the position of the patient, either head-down as for gynecologic procedures or head-up as for laparoscopic cholecystectomy. Positioning of the patient is an important step of the surgical process, providing the required access to the structures that must be visualized or manipulated during the surgical procedure. A patient to be anesthetized usually starts in the supine position, which can be changed to head-down, head-up, or other positions depending on the surgical procedure. Body responses to changes in positioning are caused by gravity. The effects of changing patient position on BIS values, however, have not been described. The purpose of this prospective, observational study was to compare the effects of changing the patient's position on BIS scores during general anesthesia.Evidence for PracticeGeorge Allen10.1016/j.aorn.2010.05.027AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XEvidence for Practice364368http://www.aornjournal.org/article/PIIS0001209210006575/abstract?rss=yes Effective leadership skills are essential in today's marketplace. This is true for employees as well as managers. This book contains valuable information that can be applied in all business areas, including the health care setting. The book is made up of 23 short research-based lessons, written by renowned business leaders, which can be read in sequence or individually based on the reader's interest. The style of the lessons vary from a theoretical global focus to practical tips and behaviors that can be used to advance any relationship in the reader's life.The AMA Handbook of LeadershipMichelle R. Tinkham10.1016/j.aorn.2010.06.006AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XReviews369370http://www.aornjournal.org/article/PIIS0001209210006587/abstract?rss=yes It has been a very long time since I have read an introductory nursing textbook, and I thought it might be interesting to read a current textbook to see how it compares with my experience working in the OR. This book was a good choice. Although I thought it would be an overview of perioperative nursing, it was a detailed introduction, from the first chapter, “Perioperative nursing,” to the last chapter, “Professional development and future roles and practice.”Perioperative Nursing: An Introductory TextPamela G. Zimmerman10.1016/j.aorn.2010.06.007AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XReviews370371http://www.aornjournal.org/article/PIIS0001209210006563/abstract?rss=yes This is an excellent book that provides a wealth of information on the practice of labor and delivery nursing. The authors are highly qualified and experienced obstetric nurses and the reading imparts a sense of wisdom, guidance, and “lessons learned” being passed on from experts in the field to the novice or proficient labor and delivery nurse. Any nurse with a desire to increase competence and confidence in the area of labor and delivery nursing will benefit greatly from the teaching provided in this evidence-based manual.Labor and Delivery Nursing: A Guide to Evidence-Based PracticeSharon A. Van Wicklin10.1016/j.aorn.2010.06.005AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XReviews371372http://www.aornjournal.org/article/PIIS0001209210006939/abstract?rss=yesA 19-year-old man presented to the emergency department with respiratory distress after blunt chest trauma. A digital chest radiograph was labeled backward; a “left” marker was mistakenly placed over the right chest. A moderate pneumothorax was visible on the film on the anatomic left side (ie, the side of the aortic arch). The pneumothorax appeared to be on the patient's right, however, because the radiograph was marked incorrectly.X-ray Flip10.1016/j.aorn.2010.05.025AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XPerioperative Grand Rounds374374http://www.aornjournal.org/article/PIIS0001209210007787/abstract?rss=yesTable of Contents10.1016/S0001-2092(10)00778-7AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XFrontmatterA3A3http://www.aornjournal.org/article/PIIS0001209210007799/abstract?rss=yesEditorial Board10.1016/S0001-2092(10)00779-9AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XFrontmatterA6A6http://www.aornjournal.org/article/PIIS0001209210007805/abstract?rss=yesOrders, claims, online, change of address: Elsevier Health Sciences Division, Subscription Customer Service, 3251 Riverport Lane, Maryland Heights, MO 63043; telephone: (800) 654-2452 (United States and Canada), (314) 447-8871 (outside United States and Canada); fax: (800) 225-4030 (United States and Canada), (314) 447-8029 (outside United States and Canada); e-mail: JournalsCustomerService-usa@elsevier.com (for print support); JournalsOnlineSupport-usa@elsevier.com (for online support). Address changes must be submitted four weeks in advance.Information for Readers10.1016/S0001-2092(10)00780-5AORN Journal 92, 3 (2010)2010-09-01AORN Journal2010-09-01923S0001-2092(10)X0014-XFrontmatterA10A10