Strategies to Implement a Competency Assessment Verification Program.

Professional role competence is an essential element of nursing practice and an integral component of providing safe perioperative patient care. In the health care setting, verifying professional role competence and managing the associated documentation can be complex. Educators can use a variety of modalities (eg, flipped classrooms, gaming, podcasts) to present information in a manner that supports adult learning principles. When developing a competency assessment verification program, perioperative leaders should use a structured model to provide consistency; they also should partner with staff members and other key stakeholders (eg, surgeons, risk management personnel) to identify and prioritize ongoing competencies. The leaders and educators should identify competency verification methods, and leaders should designate qualified observers if needed. Documentation of competency activities should be stored in an easily accessible location. Implementing a standardized competency assessment verification program is a best practice that should result in improved patient outcomes.

Just Culture: The Foundation of Staff Safety in the Perioperative Environment.

In today's perioperative setting, staff members are potentially exposed to a variety of safety and environmental concerns. As health care organizations implement measures to provide safe environments for perioperative team members, organizational leaders must pivot away from antiquated mindsets and responses and other hierarchical models of leadership. Foundational to creating and fostering safe environments is providing an atmosphere in which staff members, regardless of their role, are empowered to speak up for safety. This article defines a just culture; explores the critical elements of a just culture, including psychological safety, leader and staff member responsibilities, and staff member empowerment; and provides tools and resources that may be beneficial for leaders who are creating a just culture for staff safety in the perioperative setting.

Translating Evidence Into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best Practice.

Nursing is an information-intensive profession, requiring nurses to have high information literacy and the skills to find, understand, evaluate, and use information from a multitude of sources. The advanced practice RN (APRN) is a valuable resource to support and guide nurses in this effort. The APRN's skills encompass understanding and implementing evidence-based practice, evaluating the organizational structure (eg, units, facilities, multisystem organizations) across the continuum of care, and facilitating collaboration between perioperative nurses and other interprofessional team members to sustain practice changes in the clinical setting. Perioperative APRNs play an important role as evidence-based practice experts to assist with translating research and evidence into clinical practice for safe, quality care in the perioperative setting.

Radioactive Seed Localization Program for Patients With Nonpalpable Breast Lesions.

Without early diagnosis and treatment, many lives are lost to breast cancer. Increased breast cancer awareness has facilitated research to guide health care providers toward improving patient outcomes. Research in diagnostic and treatment modalities has expanded to focus on improving the quality of life for patients with breast cancer who are living longer than expected. Providers can offer patients with nonpalpable breast lesions new screening techniques and improved treatment options, including radioactive seed localization lumpectomy. This treatment offers patients the potential for decreased tumor re-excision for positive margins near the surgical site, a lower volume of excised breast tissue, decreased operative time, convenient surgical scheduling, and less pain. Additionally, radioactive seed localization lumpectomy can improve patient and staff member satisfaction.

Guideline Implementation: Surgical Smoke Safety.

Research conducted during the past four decades has demonstrated that surgical smoke generated from the use of energy-generating devices in surgery contains toxic and biohazardous substances that present risks to perioperative team members and patients. Despite the increase in information available, however, perioperative personnel continue to demonstrate a lack of knowledge of these hazards and lack of compliance with recommendations for evacuating smoke during surgical procedures. The new AORN "Guideline for surgical smoke safety" provides guidance on surgical smoke management. This article focuses on key points of the guideline to help perioperative personnel promote smoke-free work environments; evacuate surgical smoke; and develop education programs and competency verification tools, policies and procedures, and quality improvement initiatives related to controlling surgical smoke. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Guideline Implementation: Patient Information Management.

Clinical documentation captured in a patient's record provides health care personnel with information that can be used to guide patient care. Data collected in electronic health records can be accessed and aggregated across the health care delivery system to enhance the safety, quality, and efficacy of care. The updated AORN "Guideline for patient information management" provides guidance to perioperative personnel on documenting and managing patient information. This article focuses on key points of the guideline, which address data capture that supports the clinical workflow, incorporation of professional guidelines and standards as well as regulatory and mandatory reporting elements, use of standardized clinical terminologies, data aggregation for use in research and analytics, considerations for patient care orders, and safeguards for the patient's security and confidentiality. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Guideline Implementation: Prevention of Retained Surgical Items.

A surgical item unintentionally retained in a patient after an operative or other invasive procedure is a serious, preventable medical error with the potential to cause the patient great harm. Perioperative RNs play a key role in preventing retained surgical items (RSIs). The updated AORN "Guideline for prevention of retained surgical items" provides guidance for implementing a consistent, multidisciplinary approach to RSI prevention; accounting for surgical items; preventing retention of device fragments; reconciling count discrepancies; and using adjunct technologies to supplement manual count procedures. This article focuses on key points of the guideline to help perioperative personnel provide optimal care during a procedure. Key points addressed include taking responsibility for RSI prevention as a team; minimizing distractions, noise, and interruptions during counts; using consistent counting methods; reconciling discrepancies; and participating in performance-improvement activities. Perioperative RNs should review the complete guideline for additional information and for guidance in writing and updating policies and procedures.

Guideline Implementation: Moderate Sedation/Analgesia.

Moderate sedation/analgesia is practiced in a variety of settings and delivered by a variety of health care providers, with a goal of reducing the patient's anxiety and discomfort during diagnostic and therapeutic procedures. The updated AORN "Guideline for care of the patient receiving moderate sedation/analgesia" provides guidance on RN administration of moderate sedation/analgesia within the scope of nursing practice as defined by the state boards of nursing. The guideline addresses patient selection and assessment, staffing for the procedure, patient monitoring, medication administration, and criteria for postoperative discharge. This article focuses on key points of the guideline to promote safe care throughout the perioperative continuum for a patient receiving moderate sedation/analgesia. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Guideline Implementation: Radiation Safety.

Because radiologic technology is used in a variety of perioperative procedures and settings, it is essential for perioperative RNs to be knowledgeable of the risks related to radiation and the ways to adequately protect patients and health care providers from unintended radiation exposure. The updated AORN "Guideline for radiation safety" provides guidance on preventing injury from ionizing radiation exposure during therapeutic, diagnostic, and interventional procedures. This article focuses on key points of the guideline to help perioperative personnel practice radiation safety. The key points address the requirements for an organization's radiation safety program, measures used to keep radiation exposure as low as reasonably achievable, proper handling and testing of radiation protection devices, and considerations for protecting employees and patients who are pregnant and who will be exposed to radiation. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Is Nursing Care Missed? A Comparative Study of Three North Carolina Hospitals.

Results of a survey measuring frequency, types, and reasons for missed care at three acute care hospitals in North Carolina are described. Results also are compared to those of a previous, similar study in the midwestern United States.

The bariatric patient: an overview of perioperative care.

Obesity (ie, a body mass index of ≥30 kg/m(2)) is increasing in the United States. As a result, more overweight individuals are being surgically treated for weight loss, thus making it imperative for perioperative RNs to understand obesity's effects on patients' health, its contribution to significant comorbidities (eg, diabetes, cardiovascular disease, hypertension, sleep apnea, musculoskeletal issues, stroke), the perioperative care requirements (eg, specialized instruments and equipment, positioning and lifting aids), and unique needs of these patients (eg, diet, counseling). It is vital that the perioperative nurse accurately assesses the patient undergoing bariatric surgery to provide safe and appropriate nursing interventions during the perioperative continuum of care.

Guideline implementation: local anesthesia.

It is not uncommon in perioperative settings for patients to receive local anesthesia for a variety of procedures. It is imperative for patient safety that the perioperative RN has a comprehensive understanding of best practices associated with the use of local anesthesia. The updated AORN "Guideline for care of the patient receiving local anesthesia" provides guidance on perioperative nursing assessments and interventions to safely care for patients receiving local anesthesia. This article focuses on key points of the guideline to help perioperative personnel become knowledgeable regarding best practice as they care for this patient population. The key points address patient assessment, the importance of having an overall understanding of the local agent being used, recommended monitoring requirements, and potential adverse events, including life-threatening events. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.