Cecil A. King

Selection of a Method to Rate the Strength of Scientific Evidence for AORN Recommendations

The use of scientific evidence to support national recommendations about clinical decisions has become an expectation of multidisciplinary health care organizations. The objectives of this project were to identify the most applicable evidence-rating method for perioperative nursing practice, evaluate the reliability of this method for perioperative nursing recommendations, and identify barriers and facilitators to adoption of this method for AORN recommendations. A panel of perioperative nurse experts evaluated 46 evidence-rating systems for quality, quantity, and consistency. We rated the methods that fully covered all three domains on five aspects of applicability to perioperative nursing practice recommendations. The Oncology Nursing Societys method was rated highest for all five aspects of applicability, and interrater reliability of this method for perioperative recommendations was 100%. Potential barriers to implementation of the rating method include knowledge deficit, staff resources, resistance to change, and fear of showing that lower levels of evidence support some recommendations. Facilitators included education, resource allocation, and starting small. Barriers and facilitators will be considered by the implementation team that will develop a plan to achieve integration of evidence rating into AORN documents. The AORN Board of Directors approved adoption of this method in June 2010.

Safe Injection Practices for Administration of Propofol

Sepsis and postoperative infection can occur as a result of unsafe practices in the administration of propofol and other injectable medications. Investigations of infection outbreaks have revealed the causes to be related to bacterial growth in or contamination of propofol and unsafe medication practices, including reuse of syringes on multiple patients, use of single-use medication vials for multiple patients, and failure to practice aseptic technique and adhere to infection control practices. Surveys conducted by AORN and other researchers have provided additional information on perioperative practices related to injectable medications. In 2009, the US Food and Drug Administration and the Centers for Disease Control and Prevention convened a group of clinicians to gain a better understanding of the issues related to infection outbreaks and injectable medications. The meeting participants proposed collecting data to persuade clinicians to adopt new practices, developing guiding principles for propofol use, and describing propofol-specific, site-specific, and practitioner-specific injection techniques. AORN provides resources to help perioperative nurses reduce the incidence of postoperative infection related to medication administration.

Ethics in Perioperative Practice—Values, Integrity, and Social Policy

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and should be prepared to take action based on the ethical code outlined in the American Nurses Associations (ANAs) Code of Ethics for Nurses with Interpretive Statements. In this final article of a nine-part series that is designed to help perioperative nurses relate the ANA code to their own area of practice, the author looks at the ninth provision, which emphasizes the responsibility of professional nursing associations to maintain the value and integrity of the profession.

To err is human, to drift is normalization of deviance.

ient S The Institute of Medicine’s report To Err is Human: Building a Safer Health System has been a catalyst for change, enabling health care professionals to tear down the wall of denial that nurses and physicians are infallible and building acceptance that humans are susceptible to committing errors. This report has influenced several patient safety initiatives on national and international levels (eg, the Universal Protocol, the Surgical Care Improvement Project, the Safe Surgery Saves Lives campaign). These initiatives emphasize the need to change the culture of health care and understand the sociological variables that contribute to a culture of patient safety.

Ethics in perioperative practice--advancing the profession.

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and should be prepared to take action based on the ethical code outlined in the American Nurses Associations (ANAs) Code of Ethics for Nurses with Interpretive Statements. In this seventh of a nine-part series that is designed to help perioperative nurses relate the ANA code to their own area of practice, the author looks at the seventh statement, which emphasizes commitment to the profession.

Clinical Ethics: Patient and Provider Safety

lorence Nightingale said, “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm,” but perioperative nursing practice is indeed grounded in the ethical principles of beneficence and nonmaleficence. The AORN Perioperative Explications for the ANA Code of Ethics for Nurses and Guidelines for Perioperative Practice define the moral obligations inherent in the practice of perioperative nursing to promote patient and provider safety. To meet these obligations, perioperative nurses have the professional responsibility to provide safe patient care and to maintain a safe work environment.

Health care worker safety in surgery.

Nursing is ranked as one of the occupations with the most incidences of workplace-related injury and illness. The six types of injury risk specific to the perioperative environment are biological, ergonomic, chemical, physical, psychosocial, and cultural in nature. Strategies to improve safety include the use of engineering controls to change the work environment, the equipment used, and how the work is done; administrative controls, such as implementing policies and procedures to develop a culture of safety; and behavioral controls that individuals can exercise to reduce the risk of injury. In addition, every perioperative RN is responsible for following safety policies and has the responsibility to identify safety hazards, take appropriate actions, and report the hazards through appropriate channels.