Guidelines in Practice: A Safe Environment of Care.

Creating a safe environment for performing surgical procedures is essential to achieve successful patient outcomes and protect the perioperative personnel who are providing care. Numerous factors challenge the provision of a safe environment of care and create a complex setting for perioperative nurses to manage. The updated AORN "Guideline for a safe environment of care" provides perioperative nurses with recommendations for establishing a safe environment for both patients and personnel. This article provides an overview of the guideline and discusses recommendations for implementing fire safety protocols, using warming cabinets, and creating a latex-safe environment. It also includes a scenario describing the care of a patient with an unidentified latex allergy who is undergoing a laparoscopic sleeve gastrectomy and hiatal hernia repair. Perioperative nurses should review the guideline in its entirety and implement recommendations as applicable in operative and other procedural settings.

A qualitative study of nurse-perceived barriers to body temperature management in postoperative patients.

Although evidence-based practices exist for preventing hypothermia in patients during surgery, few studies have focused on this concern in postoperative patients. The aim of this qualitative study was to explore the most challenging issues experienced by surgical ward nurses while managing the body temperature of adult surgical patients. To address this research gap, this study used a qualitative descriptive design to document barriers to body temperature management as reported by a sample of 16 perioperative nurses. The semi-structured, face-to-face interviews were digitally recorded, transcribed verbatim and analysed using inductive content analysis. The main barriers fell into three categories: professional nursing ability limitations, unfavourable working conditions and management of human resources. The eight subcategories were disadvantageous professional views, professional knowledge limitations, low motivation to provide nursing care, non-standard treatment environment, inadequate equipment and care protocols, heavy nursing care loads, inadequate staff training and ineffective staff supervision. These findings highlighted the importance of adequate resources, proper education and evidence-based care protocols in the effective delivery of body temperature management to postoperative patients.

Controle de materiais e instrumental cirúrgico no intraoperatório: percepção e estratégias utilizadas por instrumentadores / Control of materials and surgical instruments in the intraoperative period: perception and strategies used by surgical technologists

Objetivo: Conhecer as estratégias utilizadas por instrumentadores para o controle de materiais e instrumental cirúrgico no intraope-ratório. Método: Estudo descritivo e qualitativo, realizado em hospital privado. Participaram 13 instrumentadores cirúrgicos. Os dados foram coletados entre agosto e setembro de 2022 por meio de entrevistas gravadas em áudio. Como instrumento para coleta dos dados, utilizou-se um roteiro estruturado, contendo sete perguntas, e questões referentes ao perfil da amostra. Foram incluídos técnicos de enfermagem forma-dos, atuantes como instrumentadores cirúrgicos. Foram excluídos instrumentadores ausentes no período da coleta de dados. Os dados foram analisados por meio da análise de conteúdo. Resultados: Com base na análise dos dados, emergiram quatro categorias: protocolo de cirurgia segura; controle de materiais e instrumentais; desafios no seguimento do protocolo de cirurgia segura; facilitadores do seguimento do proto-colo de cirurgia segura. Conclusão: Pôde-se conhecer as estratégias utilizadas por instrumentadores cirúrgicos para o controle dos materiais dispostos na mesa de instrumentação durante o intraoperatório. Pressa de profissionais, falta de adesão e o não seguimento de rotinas insti-tucionais caracterizam-se como desafios para o seguimento das etapas do protocolo de cirurgia segura

Objective: To know the strategies used by surgical technologists to control materials and surgical instruments in the intraopera-tive period. Method: This qualitative descriptive study was carried out in a private hospital. A total of 13 surgical technologists participated in the research. Data were collected during audio-recorded interviews between August and September 2022. The data collection instrument was a structured questionnaire consisting of seven questions, as well as items related to the sample profile. We included trained nursing technicians, working as surgical technologists. Those who were absent during data collection were excluded. Data were analyzed by con-tent analysis. Results: The data analysis produced four categories: surgical safety checklist; control of materials and instruments; challenges in following the surgical safety checklist; facilitators to following the surgical safety checklist. Conclusions: The study allowed us to know the strategies used by surgical technologists to control the materials arranged on the instrument table during the intraoperative period. The haste of professionals, lack of adherence, and non-compliance with institutional routines are regarded as challenges in following the steps of the surgical safety checklis

Objetivo: Conocer las estrategias utilizadas por instrumentistas para el control de materiales e instrumental quirúrgico en el intraope-ratorio. Método: Estudio descriptivo y cualitativo, realizado en hospital privado. Participaron 13 instrumentistas quirúrgicos. Los datos fueron colectados entre agosto y septiembre de 2022 por medio de entrevistas grabadas en audio. Como instrumento para colecta de los datos, se utilizó um guion estructurado, conteniendo siete preguntas, y cuestiones referentes al perfil de la muestra. Fueon incluidos técnicos de enfermería egre-sados, actuantes como instrumentistas quirúrgicos. Fueron excluidos instrumentistas ausentes en el período de la colecta de datos. Los datos fue-ron analizados por medio del análisis de contenido. Resultados: Con base en el análisis de los datos, emergieron cuatro categorías: protocolo de cirugía segura; control de materiales e instrumentales; desafíos en el seguimiento del protocolo de cirugía segura; facilitadores del seguimiento del protocolo de cirugía segura. Conclusión: Se pueden conocer las estrategias utilizadas por instrumentistas quirúrgicos para el control de los materiales dispuestos en la mesa de instrumentación durante el intraoperatorio. Prisa de profesionales, falta de adhesión y el no seguimiento de rutinas institucionales se caracterizan como desafíos para el seguimiento de las etapas del protocolo de cirugía segura

Perioperative nurses' experiences in relation to surgical patient safety: A qualitative study.

Surgical patient safety remains a concern worldwide as, despite World Health Organization recommendations and implementation of its Surgical Safety Checklist, adverse events continue to occur. The aim of this qualitative study was to explore the views and experiences of perioperative nurses regarding the factors that impact surgical patient safety. Data were collected through five focus groups involving a total of 50 perioperative nurses recruited from four public hospitals in Spain. Content analysis of the focus groups yielded four main themes: personal qualities of the perioperative nurse, the surgical environment, safety culture, and perioperative nursing care plans. One of the main findings concerned barriers to the exercise of leadership by nurses, especially regarding completion of the Surgical Safety Checklist. Some of the key factors that impacted the ability of perioperative nurses to fulfil their duties and ensure patient safety were the stress associated with working in the operating room, time pressures, and ineffective communication in the multidisciplinary team. Targeting these aspects through training initiatives could contribute to the professional development of perioperative nurses and reduce the incidence of adverse events by enhancing the surgical safety culture.

Protocolo de cirurgia segura: análise da produção e execução em dois hospitais terciários / Surgical safety checklist: analysis of its elaboration and implementation in two tertiary hospitals / Protocolo de cirugía segura: análisis de producción y ejecución en dos hospitales terciarios

Objetivo: Analisar o processo de produção e execução do protocolo de cirurgia segura em dois hospitais terciários do município de Manaus. Método: Pesquisa guiada pelo design thinking, com ênfase na técnica do duplo diamante, realizada em dois hospitais públicos no município de Manaus, de julho de 2018 a março de 2019. Foi feita nas etapas: investigativa (observação e questionário) e interventiva (síntese, ideação e entrega). Resultados: Na primeira etapa, com 120 horas de observação, constatou-se que as três fases do protocolo não foram cumpridas; analisando-se as repostas a 63 questionários, reforçou-se a não adesão ao checklist. Com base nesses achados, na etapa de síntese, elegeu-se como foco a aplicação do checklist do protocolo; na etapa de ideação, realizou-se a proposição de solução e a testagem-piloto; a etapa de entrega da solução aos hospitais encerrou o ciclo. Conclusão: A análise do processo de execução do protocolo indicou seu descumprimento, o que sugere o comprometimento da segurança do paciente. A solução testada poderá, após entrega e implementação, contribuir para a execução efetiva do protocolo.

Objective: To analyze the process of elaboration and implementation of the surgical safety checklist in two tertiary hospitals in the city of Manaus. Method: This study was based on design thinking, focusing on the double diamond technique. It was conducted in two public hospitals in Manaus, from July 2018 to March 2019. The following stages were adopted for this research: investigation (observation and questionnaire) and intervention (synthesis, ideation, and delivery). Results: The first stage, consisting of 120 hours of observation, showed the non-fulfillment of the three phases of the process. After analyzing the answers to the 63 questionnaires, we confirmed the non-adherence to the checklist. Based on these findings, the synthesis phase focused on the use of the checklist; the ideation phase involved the proposal of solutions and the pilot testing; the delivery phase concluded the cycle by providing solutions to the hospitals. Conclusion: The analysis of the process of implementation of the checklist indicated non-compliance, suggesting risk to patient safety. After delivery and implementation, the tested solution may contribute to the effective execution of the checklist.

Objetivo: Analizar el proceso de producción y ejecución del Protocolo de Cirugía Segura en dos hospitales terciarios de la ciudad de Manaus. Método: Investigación guiada por Design Thinking, con énfasis en la técnica Double Diamond, llevada a cabo en dos hospitales públicos de la ciudad de Manaus, desde julio de 2018 hasta marzo de 2019. Se realizó por etapas: de investigación (observación y cuestionario) e intervencionista (síntesis, ideación y entrega). Resultados: En la primera etapa, con 120 horas de observación, se encontró que las tres fases del protocolo no se cumplieron; En base a las respuestas a 63 cuestionarios, se reforzó la no adhesión a la lista de verificación. Con base en estos hallazgos, en la etapa de síntesis, la aplicación de la lista de verificación del protocolo fue elegida como el foco; en la etapa de ideación, se llevaron a cabo la propuesta de solución y la prueba piloto;La etapa de entrega de la solución a los hospitales finalizó el ciclo. Conclusión: El análisis del proceso de ejecución del protocolo indicó incumplimiento, lo que sugiere comprometer la seguridad del paciente. La solución probada puede, después de la entrega y la implementación, contribuir a la ejecución efectiva del protocolo.

Eficacia de un modelo de prevención de infección de sitio quirúrgico en un hospital de segundo nivel de atención / Effectiveness of a preventive program of surgical site infection in a hospital of second level attention

OBJETIVO PRINCIPAL: Medir la eficacia de un modelo preventivo de infecciones de sitio quirúrgico en un hospital de segundo nivel de atención en Nuevo León, México. METODOLOGÍA: Se diseñó un modelo de acciones preventivas enfocadas a disminuir la tasa de infecciones de sitio quirúrgico, las cuales se efectuaron durante los momentos preoperatorio, transoperatorio y posoperatorio. Mediante listas de verificación se observaron, vigilaron, monitorizaron y controlaron factores de riesgo para infección quirúrgica. RESULTADOS PRINCIPALES: Se logró disminuir la tasa de infecciones de sitio quirúrgico en un 2.53%, reduciendo el número de casos con respecto al periodo similar previo del estudio. Cuanto mayor fue el apego al modelo preventivo, menores los casos de infección (r=-0.61, p < 0.05). CONCLUSION PRINCIPAL: Un modelo estricto de acciones preventivas de observación, vigilancia, monitoreo y control de factores de riesgo para infecciones de sitio quirúrgico, pudo ser eficaz en la disminución de la tasa de infecciones de sitio quirúrgico

OBJECTIVE: To gauge the effectiveness of a preventive model of surgical site infections into a hospital of second level attention in Nuevo León, Mexico. METHODS: A preventive actions model was designed, focused to reduce the rate of surgical site infections, which were made during the preoperative, transoperative and postoperative moments. The risk factors for the acquisition of surgical infection were observed, looked out, monitored and controlled using checklists. RESULTS: It was possible to reduce the rate of surgical sire infections in 3%, decreasing the number of cases considerably compared to the previous similar period of the study. More attachment to the preventive model, smaller cases of infection (r=-0.61, p <0.05). CONCLUSIONS: A strict model of preventive actions like observation, surveillance, monitoring and control of risk factors for infections of surgical place, it could be effective in the decrease of the rate of surgical wound infections

Risk for surgical positioning injuries: scale validation in a rehabilitation hospital.

OBJECTIVE: to validate the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning in the stratification of risk for injury development in perioperative patients at a rehabilitation hospital. METHOD: analytical, longitudinal and quantitative study. An instrument and the scale were used in the three perioperative phases in 106 patients. The data were analyzed using descriptive and inferential statistics. RESULTS: most patients showed high risk for perioperative injuries, both in the scale score with estimated time and in the real-time score, with a mean of 19.97 (±3.02) and 19.96 (±3.12), respectively. Most participants did not show skin lesions (87.8%) or pain (92.5%). Inferential analysis enabled us to assert that the scale scores are associated with the appearance of injuries resulting from positioning, therefore, it can adequately predict that low-risk patients are unlikely to have injuries and those at high risk are more likely to develop injuries. CONCLUSION: the scale validation is shown by the association of scores with the appearance of injuries, therefore, it is a valid and useful tool, and it can guide the clinical practice of perioperative nurses in rehabilitation hospitals in order to reduce risk for injuries due to surgical positioning.

Non-technical skills in operating room nursing: Ethical aspects.

BACKGROUND: Non-technical skills are cognitive and interpersonal skills underpinning technical proficiency. Ethical values and respect for human dignity make operating room nurses responsible for nursing decisions that are clinically and technically sound and morally appropriate. AIM: To learn what ethical issues operating room nurses perceive as important regarding non-technical skills. RESEARCH DESIGN: Qualitative individual in-depth interviews were conducted. The interviews were analysed using Braun and Clarke's six phases for thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT: Eleven experienced perioperative/operating room nurses working in an operating unit at a Norwegian university hospital. ETHICAL CONSIDERATIONS: Approval was given by The Norwegian Social Science Data Service in care of the hospital's Data Protection Officer. FINDINGS: Three main themes were found: respect and care for the patient, making the patient feel safe, and respect within the perioperative team. These features or themes, which incorporate collaboration and communication, are closely connected to patient safety. DISCUSSION: Defending the patient's dignity is part of caring for and respecting the patient. The manner in which the operating room team collaborates is important for the patient to feel safe and secure. Poor teamwork may have dire consequences. Reciprocal respect within the team includes respect for each other's tasks and responsibilities and to talk to one another in a friendly manner. CONCLUSION: Being respectful and contributing to a caring atmosphere are central ethical skills in the operating room. To patients, harmonious teamwork translates into a feeling of safety and being cared for. The nurses see respect and patient safety, and respect and reciprocal politeness among the members of the perioperative team as central ethical non-technical skills. Lack of respect influences the team negatively and is detrimental for patient safety. Good communication is an important safety measure during surgery and creates a feeling of good 'flow' within the operating room team.

A Qualitative Exploratory Study of Norwegian OR Nurses' Patient Positioning Priorities.

The purpose of patient positioning is to provide optimal surgical site exposure for surgical team members and prevent negative patient outcomes. This study explores perioperative nurses' experiences when positioning patients for surgery. We collected data using focus group interviews of 17 OR nurses in Norway and used qualitative content analysis to analyze the data. The study findings showed that perioperative nurses emphasized their most important priorities as concepts that can be categorized into three themes: leading and coordinating patient positioning, ensuring patient safety, and promoting efficient use of OR nurses' expertise. The study findings also identify a need to define formal responsibilities in patient positioning and processes for determining positioning outcomes. Perioperative leaders should verify OR nurse competence for patient positioning to help ensure continuity and safety in complex patient pathways.

A Practical Guide to Performance Improvement: Tools and Tips to Sustain and Control Project Improvements.

This article discusses some of the tools and tips to sustain performance improvement (PI) and explores some of the reasons why PI projects may fail. Although some PI projects seem simple and easy to implement, PI team members sometimes find it difficult to keep momentum going, maintain gains, and sustain the changes when the project is nearing completion and afterward. Team member and leader discipline, including use of multidisciplinary communication and standard work processes, can facilitate ongoing improvement. Communication may include visual displays of information and routine huddles. After reviewing this article, the reader should have a better understanding of sustaining change and promoting continuous PI. This is the fifth article of a six-part series about PI.

Guideline Implementation: Sterile Technique.

Establishing and maintaining a sterile field to help prevent surgical site infections requires specific knowledge and skills and is among the most important responsibilities of the perioperative RN. Perioperative RNs should remain vigilant in monitoring the sterile field, communicate when a break in sterile technique occurs, and collaborate with other surgical team members to correct the break in technique. The AORN "Guideline for sterile technique" provides guidance to perioperative personnel on the principles and processes of sterile technique. This article elaborates on key takeaways from the guideline, including using sterile technique when donning sterile gowns and gloves, delivering sterile items to the sterile field, using drapes to establish a sterile field, and maintaining the sterile field. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Guideline Implementation: A Safe Environment of Care.

The OR can be a hazardous environment for both patients and personnel. Low lighting, fluid on the floor, combustible and noxious chemicals, multiple pieces of equipment with cords, the fast pace, and numerous distractions are only some of the factors that can lead to an accident or injury. The AORN "Guideline for a safe environment of care" provides guidance to perioperative personnel on identifying hazards and implementing processes to mitigate risks in the perioperative setting. This article elaborates on key takeaways from the guideline, including precautions to reduce the risk of OR fires; occupational injuries associated with slips, trips, and falls; and handling, storing, and using hazardous chemicals. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.