Adapting charting by exception to the perianesthesia setting.

Many acute care settings are experiencing a shift toward ambulatory patient care and are being pressured to decrease patient length of stay. Meanwhile, there is increased pressure to remain patient centered and to become more customer oriented. This article describes how the authors adapted charting-by-exception principles to develop a single ambulatory surgery nursing record for use from admission to discharge. The authors' goals were to condense documentation, to decrease time spent on documentation, and to diminish the variance in quality of documentation. This article also details how the new nursing record measures achievement of patient outcomes, with a focus of promoting street readiness.

Triple arthrodesis.

Triple arthrodesis is the surgical fusion of the calcaneocuboid, talonavicular, and talocalcaneal joints of the foot. This is a palliative surgical procedure used to treat many painful hindfoot disorders (eg, clubfoot deformity, arthritis, Charcot's joint disease). Patient benefits include pain relief and improvement in foot function. Several anesthesia options are available for intraoperative and postoperative pain management. Perioperative nurses should be knowledgeable about foot anatomy, the sequence of surgical events, and possible postoperative complications from triple arthrodesis. A systems approach to patient care throughout the perioperative phase can ensure optimal patient outcomes.

Developing competency-based perioperative orientation programs.

Ensuring the competency of staff members at all levels of practice is an ongoing challenge for perioperative clinical educators. The authors developed a competency-based orientation program using AORN's perioperative nursing competency statements as a conceptual framework. The model also incorporates requirements from external regulatory agencies (e.g., the Joints Commission on Accreditation of Healthcare Organizations) that influence the direction of health care institutions seeking accreditation. The model provides the components necessary to validate the orientation of perioperative staff members and the delivery of comprehensive nursing care in perioperative settings.

Intraoperative pressure sore prevention: an analysis of bedding materials.

The relationship between operating room (OR) table surfaces and skin integrity was examined. Preoperatively, patients (N = 505) were rated for pressure sore potential (Hemphill); postoperatively, skin condition was assessed. Skin changes were more likely with a standard mattress only or with surgery longer than 2.5 hr. The overlay was more effective than the foam and gel or standard foam mattresses for preventing pressure sore formation. Factors predictive of pressure sore development included surgery of 2.5+ hr, 40+ years, vascular disease, and a preoperative Hemphill value of 4+. Patient characteristics, surgical experience variables, and OR table surfaces are determinants in pressure sore development.

Role for short-range interactions in the formation of cartilage and muscle masses in transfilter micromass cultures.

In the embryonic limb bud, chondrogenic and myogenic regions arise by segregation from a mixture of chondrogenic and myogenic precursor cells (Schramm and Solursh, 1990). In in vitro micromass cultures, dissociated limb bud cells also segregate into chondrogenic and myogenic tissues. The process of segregation was studied using transfilter micromass cultures to determine the role of short-range interactions in the formation of these two tissue masses. Limb bud cells were plated on both sides of large and small Nucleopore filters. Pore size was chosen to permit cell-cell or cell-extracellular matrix contact across large pore filters but permit only interactions via diffusible molecules across small pore filters. Cultures were plated at high density on one surface to allow formation of chondrogenic nodules and at high or low density on the opposing surface to observe any segregation effect on chondrogenic and myogenic cells, respectively. Spatially organized extracellular matrix of micromass cultures was fixed by cold ethanol precipitation onto filters. The fixed micromass cultures lost the ability to affect segregation across the filter. These results suggest that chondrogenic aggregates enlarge in an autocrine manner dependent on direct cell-cell or cell-extracellular matrix contact provided by living cells. Myogenic segregation likely occurs in a paracrine manner that also requires short-range interactions.