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AORN guidance statement: sharps injury prevention in the perioperative setting.

Occupational exposure to bloodborne pathogens via percutaneous injuries is one of the most serious dangers perioperative team members face on a daily basis. The risk of sustaining a percutaneous injury can be decreased through employee education, clear communication, device engineering, and focused work practice controls. Risk reduction strategies should include specific practices aimed at reducing the unique risks of percutaneous injuries encountered in the perioperative environment. AORN recognizes the various settings in which perioperative RNs practice, and the suggested risk reduction strategies in this guidance statement are intended to be adaptable to any setting where surgical or other invasive procedures are performed.

Blood-Borne Pathogens↗

AORN guidance statement: perioperative staffing. Association of periOperative Registered Nurses.

One of the most important responsibilities of a perioperative nursing leader is the development of an effective staffing plan relative to surgical patients' needs. AORN recognizes there are a variety of settings in which perioperative RNs practice. This guidance statement is intended to serve as a guide for perioperative nursing leaders in developing a staffing plan and is designed to be adaptable to various practice settings.

Emergencies↗

Toward 2001. The recovery room revisited.

Recovery room nursing is more accurately described by the term "post-anaesthesia nursing." Issue of patient safety, standards of care and staff training in the recovery room have been highlighted by the Association of Anaesthetists in two reports. Current training and education provision for post-anaesthesia nurses is provided by combined operating department nursing and anaesthetic nursing curricula (ENBI182:83). There are few courses designed for nurses who specialize in the care of the post-anaesthesia patient.

Clinical Competence↗

Postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV) is a widespread and often underestimated problem that invariably falls onto the shoulders of nursing staff. In order to find out how nurses view this condition, a major survey was conducted amongst members of the National Association of Theatre Nurses.

Attitude of Health Personnel↗

Pediatric patient education for the operating room staff: the "Barney phenomenon".

The single most important determinant of a child's ability to learn is the child's readiness to accept the information and incorporate it into his frame of reference. To be an effective educator of children, the nurse must understand the following: (1) the child's developmental stage, (2) the tasks and fears associated with that stage, and (3) the ability of the child to understand the concepts being taught. Before teaching can begin, fears and anxieties must be overcome. Each developmental stage, from birth through adolescence is examined from the perspective of the perioperative nurse conducting a teaching program for children and their parents. Guidelines and suggestions for age-appropriate activities to reduce anxiety and teaching methods are emphasized.

Adolescent↗

Operating room registered nurses internship program. A recruitment and retention strategy.

The acute nursing shortage, particularly in perioperative nursing, was a driving force for the creation of a registered nurse (RN) internship program. The program was developed according to the Association of periOperative Nurses (AORN) Standards and Recommended Practices and national practice. Program evaluations led to positive changes in the program. This article describes the process that was followed and the unique features of the program.

Education, Nursing, Continuing↗

Nursing implication for pulmonary artery balloon counterpulsation: a treatment for right ventricular dysfunction after cardiac surgery.

PPRVD is a phenomenon frequently observed in the operating room. Its development can be attributed to a single or many factors associated with cardiac operation. Namely, its presence is precipated by injury to the RV myocardium or changes in the normal hemodynamic functions of the RV. While PPRVD occurs in isolation, it is usually seen with concomitant LV dysfunction. When conventional medical management of LV dysfunction does not improve yet unmasks RV dysfunction, some type of ventricular assist device to support RV dysfunction may be needed to wean patients from cardiopulmonary bypass such as PABC. PABC has been demonstrated to be useful in the management of mild to moderate PPRVD and weaning from CPB. Severe PPRVD has not been demonstrated to benefit from PABC. The major concern in managing PPRVD is the lack of quantifiable criteria for determining levels of RV injury. Research is continuing in this area. Likewise, investigations are under way to develop a transvenous PABC catheter. This catheter would allow for increased PABC use as it would not require surgical placement or removal. The present PABC model could potentially be used in any hospital that uses conventional intra-aortic balloon counterpulsation. The patient presented in this case was cared for in a 350-bed community hospital in the Northeast section of the United States. A PABC patient can present a unique nursing challenge. It is hoped that this article will assist nurses in the future management of these patients.

Aged↗

Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center.

OBJECTIVE: To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital. DESIGN: Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections. SETTING: A university referral center in Canada. PATIENTS: Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991. MEASUREMENTS: During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs. RESULTS: We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing $394,337. Fifty-five emergency and 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were $321,533 in total, or $3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%. CONCLUSIONS: Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.

Hospital Bed Capacity, 300 to 499↗

Understanding conscious sedation in the operating room.

Conscious sedation is an appropriate choice for patients who do not require a general anesthetic, but rather need sedation to alleviate anxiety, minimize the discomfort of less invasive surgical procedures, or even to tolerate a regional or local anesthetic. New pharmaceutical agents, with their short half lives, provide amnesia, analgesia, and sedation quite safely. This concept, combined with standardized and controlled safety monitoring, offers an anesthetic alternative quite acceptable to many patients and health care providers. Standards and guidelines have been extensively developed by the American Society of Anesthesiologists, and the American Association of Nurse Anesthetists, to set forth a practice for all providers that will promote patient safety and provider vigilance (AANA, 1998). The purpose of this article is to review the process of conscious sedation.

Procedural Sedation↗

Implications of transplantation surgery for theatre nurses: 1.

Transplant donors, although legally dead, arrive in operating theatre departments appearing no different from any other preoperative patient. Some theatre staff may not appreciate, or even be aware, that transplant donors have been certified dead before donor surgery. This article, the first of two-parts, examines the implications of organ donation surgery for the emotional and psychological wellbeing of nursing staff. Other potential problems for nursing staff, related to the process of organ retrieval, are also explored. These include the scheduling of transplant work at times when there is a poor level of skill mix, difficulties in working with unfamiliar staff and equipment, the apparent lack of 'benefit' of surgery for donor patients, and the possibility of identifying with the victims of sudden and perhaps traumatic death. The second article, to be published in the next issue, will discuss ways of ameliorating the stress associated with this work.

Attitude of Health Personnel↗

From one to another.

Organ transplantation is now well established as an excellent treatment for many previously fatal diseases of vital organs. For an organ to be of use to the recipient the cells must be alive but apart from kidney and hepatic lobe donation from a close blood relative, organs are removed from dead patients. The cause of death is usually a head injury or intracerebral bleed with permanent and complete destruction of the brain stem. Thus organ donation to save a life is usually associated with a tragedy for the donors and their families.

Humans↗