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    Clinical Issues-September 2017.
    AORN J 2017 Sep;106(3):254-261
    Performing Staphylococcus aureus decolonization for urgent procedures Key words: decolonization, Staphylococcus aureus, MRSA, MSSA, mupirocin. Hand hygiene before donning gloves Key words: hand hygiene, glove, personal protective equipment. Hand hygiene before skin prep Key words: hand hygiene, skin prep, sterile task, aseptic task. Read More

    Guideline Implementation: Positioning the Patient.
    AORN J 2017 Sep;106(3):227-237
    Every surgical procedure requires positioning the patient; however, all surgical positions are associated with the potential for the patient to experience a positioning injury. The locations and types of potential injuries (eg, stretching, compression, pressure injury) depend on the position. Factors that may increase the patient's risk for an injury are the length of the procedure and risk factors inherent to the patient (eg, weight, age, frailty). Read More

    Back to Basics: Pneumatic Tourniquet Use.
    AORN J 2017 Sep;106(3):219-226
    Pneumatic tourniquets are commonly used in surgeries involving the limbs to achieve a nearly bloodless surgery and an optimal operating field or when administering regional anesthesia during surgery on a limb. Complications can arise from the use of tourniquets, including nerve injuries, pain, compartment syndrome, pressure injuries, chemical burns, and tissue necrosis. More serious injuries-including deep vein thrombosis, thermal damage to tissues, severe ischemic injuries, and rhabdomyolysis-also can occur. Read More

    An Integrative Review of the Hands-Free Technique in the OR.
    AORN J 2017 Sep;106(3):211-218.e6
    Sharps injury rates are proportionally higher in perioperative areas than in other practice settings. The hands-free technique (HFT) has been shown to decrease the hazards of sharps injuries when passing sharps during surgery. We reviewed and synthesized research studies regarding compliance with the HFT and factors facilitating its use using a key word search of online databases and a secondary search of references. Read More

    Professional and Regulatory Infection Control Guidelines: Collaboration to Promote Patient Safety.
    AORN J 2017 Sep;106(3):201-210
    Professional organizations and regulatory agencies collaborate on infection prevention and control guidelines to support preventing and controlling infection in the surgical setting. More specifically, regulatory and accrediting agencies, professional associations, and advisory committees create and promote the use of evidence-based recommendations for preventing surgical site infections. Many agencies perform accreditation surveys to ensure compliance with these standards and guidelines. Read More

    The Effect of Offloading Heels on Sacral Pressure.
    AORN J 2017 Sep;106(3):194-200
    Offloading a patient's heels during supine surgical procedures is a common practice to prevent heel pressure injuries. This practice may increase sacral pressure and jeopardize sacral skin integrity, but prophylactic dressings may help protect sacral skin. The purpose of this study was to examine the effects of offloading the heels and of multilayered silicone foam dressings on sacral pressure. Read More

    Professional Development Strategies to Enhance Nurses' Knowledge and Maintain Safe Practice.
    AORN J 2017 Aug;106(2):99-110
    Maintaining competence is a professional responsibility for nurses. Individual nurses are accountable for their practice, as outlined in the American Nurses Association's Nursing: Scope and Standards of Practice. Nurses across clinical settings face the sometimes daunting challenge of staying abreast of regulatory mandates, practice changes, equipment updates, and other workplace expectations. Read More

    Clinical Issues-August 2017.
    AORN J 2017 Aug;106(2):162-171
    Caring for patients with tattoos undergoing magnetic resonance imaging (MRI) procedures Key words: magnetic resonance imaging, tattoos. Reducing slips, trips, and falls caused by electrical cords on the procedure room floor Key words: slips, trips, falls, electrical cords, equipment booms. Classifying surgical limb amputation wounds Key words: wound classification, documentation, amputation. Read More

    Guideline Implementation: Minimally Invasive Surgery, Part 2-Hybrid ORs.
    AORN J 2017 Aug;106(2):145-153
    Performing both surgical and imaging procedures in a hybrid OR can increase efficiency by reducing the number of patient transfers between departments and the number of patient hand overs between personnel. A hybrid OR is, however, a complex environment that requires integrating the knowledge and skills of personnel from multiple disciplines to create a successful workflow. When magnetic resonance imaging (MRI) equipment is installed in the hybrid OR, additional precautions are required to help ensure the environment is safe for patients and personnel. Read More

    Introducing Perioperative Nursing as a Foundation for Clinical Practice.
    AORN J 2017 Aug;106(2):121-127
    This article describes one school's experience in providing a perioperative nursing course as a first clinical course in a bachelor of science in nursing curriculum. This innovation reframes the perspective on perioperative nursing from that of an elective clinical specialty that is not essential to basic nursing education to a practice setting that provides key foundational clinical learning experiences for the novice nursing student. A strong academic-practice partnership; effective preparation for key stakeholders including nursing staff members, preceptors, and students; and collaboration with AORN were essential elements in the success of this clinical learning innovation. Read More

    Transitioning From Perioperative Staff Nurse to Perioperative Educator.
    AORN J 2017 Aug;106(2):111-120
    Perioperative nurses who enjoy teaching may wish to become staff development educators. The shift to this new role requires a transition period during which the new educator acquires the knowledge, skills, and attitudes integral to mastering the job. A systematic approach to achieving baseline competencies in the educator role helps to ensure a successful conversion from providing direct patient care to supporting the educational needs of staff members. Read More

    Perioperative Nursing Management of Donor and Recipient Patients Undergoing Face Transplantation.
    AORN J 2017 Jul;106(1):8-19
    Individuals with debilitating facial injuries and deformities have achieved significant improvement of aesthetic form and function after undergoing a face transplantation. The involvement of surgical technologists and perioperative nurses in the care of the recipient and donor plays a critical role in the success of these procedures. There are unique challenges that staff members may be presented with when caring for a donor and recipient undergoing a face transplantation, including less comfort with and knowledge of the surgical procedure and instrumentation, an increased amount of equipment and personnel in the OR, donor and recipient admission and discharge care, and increased shift length. Read More

    Guideline Implementation: Minimally Invasive Surgery, Part 1.
    AORN J 2017 Jul;106(1):50-59
    Since its inception in the early 1990s, technological developments have made minimally invasive surgery the preferred approach for many operative procedures. However, perioperative personnel have had to develop new skills and techniques to manage this technology. The advent of robotic-assisted procedures in the early 2000s added another level of complexity to the perioperative arena. Read More

    Back to Basics: Radiation Safety.
    AORN J 2017 Jul;106(1):42-49
    Perioperative team members and patients are frequently exposed to radiation during operative and other invasive procedures. The use of equipment that emits radiation (eg, a fluoroscopy unit) is beneficial for diagnosing and treating patients but carries the risk of harm if team members do not follow radiation safety guidelines. Perioperative team members should implement safety precautions for themselves and their patients when radiation is used. Read More

    Danish Perioperative Nurses' Documentation: A Complex, Multifaceted Practice Connected With Unit Culture and Nursing Leadership.
    AORN J 2017 Jul;106(1):31-41
    Researchers have described the documentation practices of perioperative nurses as flawed and characterized by subjectivity and poor quality, which is often related to both the documentation tool and the nurses' level of commitment. Studies suggest that documentation of nursing care in the OR places special demands on electronic health records (EHRs). The purpose of this study was to explore how the use of an EHR tailored to perioperative practice affects Danish perioperative nurses' documentation practices. Read More

    Do-Not-Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project.
    AORN J 2017 Jul;106(1):20-30
    Do-not-resuscitate (DNR) orders in the perioperative environment must be managed according to national and institutional guidelines. Health care professionals, including perioperative nurses, may be unfamiliar with the guidelines and unsure of their role in reevaluating a DNR order. We conducted a multidisciplinary quality improvement project at a metropolitan community hospital that aimed to improve health care providers' compliance with the institutional policy, nursing involvement in DNR reevaluation, and communication between providers. Read More

    Accuracy of Children's Perioperative Memories.
    AORN J 2017 Jun;105(6):605-612
    Children's declarative memories of medical procedures can influence their responses to subsequent events. No previous study has examined the accuracy of children's declarative memories after surgery. We tested the memory of 34 anesthesia-naïve five- to nine-year-old children undergoing ambulatory surgery for accuracy of contextual details, pain, and fear two weeks postoperatively. Read More

    Radioactive Seed Localization Program for Patients With Nonpalpable Breast Lesions.
    AORN J 2017 Jun;105(6):593-604
    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. Read More

    Implementing Skin-to-Skin Contact for Cesarean Birth.
    AORN J 2017 Jun;105(6):579-592
    Early skin-to-skin (STS) contact in the OR facilitates the development of mothering behaviors, breastfeeding success, and newborn adaptation to extrauterine life. A team at my institution performed a quality improvement project to implement a standard of care for STS contact in the OR during and after cesarean birth. Thirty-seven of 50 mother-infant dyads experienced STS contact in the OR or in the postanesthesia care unit. Read More

    Association Between Acute Pain and Hemodynamic Parameters in a Postoperative Surgical Intensive Care Unit.
    AORN J 2017 Jun;105(6):571-578
    I conducted a prospective repeated-measure study in the general surgery intensive care unit to investigate the associations among acute postoperative pain, analgesic therapy, and hemodynamic parameters. I selected 33 patients and recorded 84 episodes of pain. I measured intensity of pain and hemodynamic parameters after patients were transferred from the postanesthesia care unit to the general surgery intensive care unit, immediately before analgesic therapy and at 15, 30, and 45 minutes after analgesic therapy. Read More

    Enhanced Time Out: An Improved Communication Process.
    AORN J 2017 Jun;105(6):564-570
    An enhanced time out is an improved communication process initiated to prevent such surgical errors as wrong-site, wrong-procedure, or wrong-patient surgery. The enhanced time out at my facility mandates participation from all members of the surgical team and requires designated members to respond to specified time out elements on the surgical safety checklist. The enhanced time out incorporated at my facility expands upon the safety measures from the World Health Organization's surgical safety checklist and ensures that all personnel involved in a surgical intervention perform a final check of relevant information. Read More

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