Lisa Spruce

Back to Basics: Preventing Surgical Site Infections

A surgical site infection (SSI) is an unintended and oftentimes preventable consequence of surgery. There is a significant amount of literature related to preventing SSIs, and it is up to practitioners in each care setting to review the evidence and work together to implement SSI prevention measures, such as nasal decolonization, antibiotic prophylaxis, preoperative showers, preoperative oxygen supplementation, and antimicrobial sutures. In addition, practitioners can follow several recommendations to reduce the risk of SSIs, including following proper hand hygiene practices; wearing clean, facility-laundered scrub attire; following a surgical safety checklist; and speaking up when a break in sterile technique is witnessed. The benefits of preventing SSIs are preventing patient mortality and decreasing the burden that SSIs pose on the national health care system. It is up to health care leaders to drive and support SSI prevention initiatives.

An intervention to change the approach to colorectal cancer screening in primary care

Purpose: The purpose of this project was to increase colorectal cancer screening (CRC) rates in the state of Nevada. Research has shown that there are several interventions for providers to use to increase CRC screening rates in practice. The Nevada Colon Cancer Partnership (NCCP) has created a toolkit to assist providers to implement these interventions in practice. Data Sources: Research has repeatedly shown that CRC screening has a great impact on the morbidity and mortality of CRC. Studies have shown that a fecal occult blood test can detect 60–85% of CRCs and a colonoscopy with polyp removal can reduce mortality by 60–90%. Multiple studies have shown that a providers recommendation is the most consistently influential factor in cancer screening. Furthermore, offering patients a choice and encouraging active participation in health care decision making has proven to increase CRC screening rates. Conclusions: The NCCP has collaborated with the American Cancer Society to create a web based toolkit for use by providers to change practice and screen all eligible patients for CRC. The toolkit is designed to encourage providers to decrease the morbidity and mortality of CRC and other cancers. The toolkit is useful to facilitate efforts of office-based clinicians to reduce disparities by applying screening guidelines on a universal basis to the age-appropriate population. A team approach to screening is encouraged to promote an opportunistic or global approach to assure all eligible patients are reached. Implications for Practice: As healthcare reform continues to evolve, Nurse Practitioners (NPs) will assume much of the primary care needs of our country. A preventive care model is an important aspect of the future of healthcare. NPs are in a perfect position to change the health of patients in a global way. The strategies and tools presented in this toolkit are designed to improve preventive care and assist the NP in assuring that every eligible patient receives the screening tests they need.Purpose: The purpose of this project was to increase colorectal cancer screening (CRC) rates in the state of Nevada. Research has shown that there are several interventions for providers to use to increase CRC screening rates in practice. The Nevada Colon Cancer Partnership (NCCP) has created a toolkit to assist providers to implement these interventions in practice. Data Sources: Research has repeatedly shown that CRC screening has a great impact on the morbidity and mortality of CRC. Studies have shown that a fecal occult blood test can detect 60–85% of CRCs and a colonoscopy with polyp removal can reduce mortality by 60–90%. Multiple studies have shown that a providers recommendation is the most consistently influential factor in cancer screening. Furthermore, offering patients a choice and encouraging active participation in health care decision making has proven to increase CRC screening rates. Conclusions: The NCCP has collaborated with the American Cancer Society to create a web based toolkit for use by providers to change practice and screen all eligible patients for CRC. The toolkit is designed to encourage providers to decrease the morbidity and mortality of CRC and other cancers. The toolkit is useful to facilitate efforts of office‐based clinicians to reduce disparities by applying screening guidelines on a universal basis to the age‐appropriate population. A team approach to screening is encouraged to promote an opportunistic or global approach to assure all eligible patients are reached. Implications for Practice: As healthcare reform continues to evolve, Nurse Practitioners (NPs) will assume much of the primary care needs of our country. A preventive care model is an important aspect of the future of healthcare. NPs are in a perfect position to change the health of patients in a global way. The strategies and tools presented in this toolkit are designed to improve preventive care and assist the NP in assuring that every eligible patient receives the screening tests they need.

Perioperative Nursing Leaders Implement Clinical Practice Guidelines Using the Iowa Model of Evidence‐Based Practice

Many health care organizations, nursing leaders, and individual clinicians are not providing care consistently based on evidence and many are not aware of the evidence that is available. Preventable complications have an adverse effect on hospital reimbursement and the burden is placed on hospital personnel and nursing leaders to use current evidence to improve care and prevent complications, such as surgical site infections. Using AORN resources, leadership involvement and ownership, and implementing a theoretical model will contribute to implementing daily evidence-based practice and help to decrease the chasm between research and practice.

Introducing AORN's New Model for Evidence Rating

Nurses today are expected to implement evidence-based practices in the perioperative setting to assess and implement practice changes. All evidence-based practice begins with a question, a practice problem to address, or a needed change that is identified. To assess the question, a literature search is performed and relevant literature is identified and appraised. The types of evidence used to inform practice can be scientific research (eg, randomized controlled trials, systematic reviews) or nonresearch evidence (eg, regulatory and accrediting agency requirements, professional association practice standards and guidelines, quality improvement project reports). The AORN recommended practices are a synthesis of related knowledge on a given topic, and the authorship process begins with a systematic review of the literature conducted in collaboration with a medical librarian. At least two appraisers independently evaluate the applicable literature for quality and strength by using the AORN Research Appraisal Tool and AORN Non-Research Appraisal Tool. To collectively appraise the evidence supporting particular practice recommendations, the AORN recommended practices authors have implemented a new evidence rating model that is appropriate for research and nonresearch literature and that is relevant to the perioperative setting.

Surgical Head Coverings: A Literature Review

&NA; Microorganisms that cause surgical site infections may either be present on the patients skin or mucous membranes or transmitted to the patient by health care personnel, the environment, or other items in the perioperative setting. This literature review analyzes the evidence used to support the recommendation that perioperative personnel should cover their heads, hair, and ears in the semirestricted and restricted areas. A literature search produced 27 articles related to bacterial shedding from skin and hair, pathogenic organisms present on the hair and ears, and case reports of infectious organisms passed from health care providers to patients. Although there is no conclusive evidence that wearing a head covering can help prevent surgical site infections, the potential benefits to patients when compared with the risks suggest that perioperative team members should cover their heads, hair, and ears in the semirestricted and restricted areas to provide the best possible protection for surgical patients.

Back to Basics: Preventing Surgical Fires

When fires occur in the OR, they are devastating and potentially fatal to both patients and health care workers. Fires can be prevented by understanding the fire triangle and methods of reducing fire risk, conducting fire risk assessments, and knowing how to respond if a fire occurs. This Back to Basics article addresses the basics of fire prevention and the steps that can be taken to prevent fires from occurring.

AORN’s Revised Model for Evidence Appraisal and Rating

AORN perioperative practice specialists responsible for authoring the Guidelines for Perioperative Practice have spent several years using evidence-based practice tools adapted from other organizations. AORN now has its own evidence appraisal tools and model for evidence-based practice that can be used by nurses and students to appraise research and nonresearch articles and assign an evidence rating to help inform perioperative practice decisions. The new and revised tools include a new evidence rating model, hierarchy of evidence, and expanded appraisal tools.

Back to Basics: Preventing Perioperative Pressure Injuries

Pressure injury prevention is essential to patient safety in the perioperative setting. Perioperative nurses should be knowledgeable about the risk factors for pressure injury and the safety precautions that can be taken to prevent this injury from occurring. Perioperative nurses should be able to identify patients who are at high risk for developing a pressure injury. Perioperative patients are at risk for developing pressure injuries because they can experience intense or prolonged pressure during lengthy surgical procedures, may have increased pressure on bony prominences from positioning, are exposed to friction or shear during transfer to the OR bed and positioning, and often have significant comorbidities. This Back to Basics article examines the risk factors for pressure injuries in the perioperative patient population and discusses screening and prevention measures that can be implemented.

Back to Basics: Procedural Sedation

Patients undergoing surgery frequently receive procedural sedation from RNs in the perioperative setting. With appropriate training, perioperative RNs can administer procedural sedation safely and effectively, helping to eliminate the pain and anxiety often experienced by patients. Facility sedation protocols should provide guidance on training requirements, the RNs role, the credentialing process, the medications the RN may use, and when anesthesia personnel should be consulted. Creating these protocols is guided by state scope of practice laws, Centers for Medicare & Medicaid Services Interpretive Guidelines, and accreditation requirements. Training, physician guidance, and appropriate protocols give the necessary support for perioperative nurses to provide safe and effective procedural sedation.

Back to Basics: Counting Soft Surgical Goods.

Retained surgical items (RSIs) pose serious consequences for patients and are a significant threat to patient safety. Perioperative team members are morally and ethically responsible for the prevention of RSIs and should understand how to reduce the risk of occurrence. The prevention of RSIs does not rest in the hands of one individual. It is a multidisciplinary endeavor that aims to reduce the risk of RSIs, and team members should hold each other accountable. This Back to Basics article focuses on the process of counting soft surgical goods, which are the most common RSIs.