Clinical Issues-August 2017.

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. Preventing postoperative pressure alopecia Key words: alopecia, occipital neuropathy, scalp massage. Using prophylactic dressings to prevent pressure injury Key words: prophylactic dressings, silicone foam dressings, sacral dressings, heel dressings, pressure injury.

Clinical Issues- March 2017.

Using one flexible endoscope for an upper and lower gastrointestinal (GI) endoscopy procedure Key words: flexible endoscope, esophagogastroduodenoscopy, colonoscopy, enteroscope, risk assessment. Enhanced methods for processing flexible duodenoscopes Key words: flexible duodenoscopes, liquid chemical sterilization, ethylene oxide sterilization, low-temperature sterilization, risk assessment. Modification of the Spaulding classification Key words: Spaulding classification, critical items, semicritical items, mucous membranes, risk assessment. Flushing flexible endoscope lumens with alcohol Key words: flexible endoscopes, isopropyl alcohol, ethyl alcohol, fixative, risk assessment. Using chlorine dioxide wipes for nonchanneled flexible endoscopes Key words: nonchanneled flexible endoscopes, high-level disinfectant, chlorine dioxide, risk assessment.

Clinical Issues-September 2016.

Packaging multiple items in a single peel pouch Key words: peel pouch, packaging, low profile items. Closed instruments found in instrument trays Key words: closed instruments, instrument trays. Organic and inorganic material found in instrument trays Key words: organic material, inorganic material, instrument trays. Processed endoscopes touching each other Key words: endoscope storage, endoscopes touching, endoscope storage cabinet, endoscope damage, endoscope coiling. Maximum safe storage time for processed flexible endoscopes Key words: endoscope storage, endoscope storage time, risk assessment, multidisciplinary team.

Clinical Issues-May 2016.

Variations in documenting surgical wound classification Key words: surgical wound classification, clean, clean-contaminated, contaminated, dirty. Wearing long-sleeved jackets while preparing and packaging items for sterilization Key words: long-sleeved jackets, organic material, sterile processing. Endoscopic transmission of prions Key words: prions, high-risk tissue, low-risk tissue, Creutzfeldt-Jakob disease (CJD), variant Creutzfeldt-Jakob disease (vCJD). Wearing gloves when handling flexible endoscopes Key words: gloves, low-protein, powder-free, natural rubber latex gloves, latex-free gloves.

Dental avulsions: Review and recommendations.

Tooth avulsion injuries are common. This article will review causes of tooth avulsion and provide management guidelines. Recommendations for NP education and practice will be reviewed.

AORN's Revised Model for Evidence Appraisal and Rating.

AORN perioperative practice specialists responsible for authoring the Guidelines for Perioperative Practice have spent several years using evidence-based practice tools adapted from other organizations. AORN now has its own evidence appraisal tools and model for evidence-based practice that can be used by nurses and students to appraise research and nonresearch articles and assign an evidence rating to help inform perioperative practice decisions. The new and revised tools include a new evidence rating model, hierarchy of evidence, and expanded appraisal tools.

Back to basics: specimen management.

Specific actions for handling various types of specimens may differ; however, the management process is essentially the same. Accurate specimen management requires effective multidisciplinary communication, minimal distractions, and awareness of the opportunities for error. When advocating for patients and working with members of the health care team to provide a safe perioperative environment, perioperative nurses should adhere to best practices for specimen management and strive to prevent specimen-related errors that may lead to inaccurate or incomplete diagnoses, the need for additional procedures, and perhaps most importantly, physical and psychological injury to patients.

Back to basics: positioning the patient.

Positioning the surgical patient requires special attention from the entire surgical team because anesthetized or sedated patients are not able to reposition themselves when needed to relieve discomfort or alert team members of the need for repositioning. Perioperative nurses must pay attention to positioning details and the possibility of injury at all times during the patient's procedure. This includes assessing the patient's circulatory, respiratory, integumentary, musculoskeletal, and neurological structures to help ensure that the patient is properly positioned and safe from injury. Working as a member of the surgical team, the perioperative RN is key to speaking up when positioning issues need to be addressed and helping to minimize the risk of injury to the patient. This "Back to Basics" article discusses positioning the patient in the prone position.

Introducing AORN's new model for evidence rating.

Nurses today are expected to implement evidence-based practices in the perioperative setting to assess and implement practice changes. All evidence-based practice begins with a question, a practice problem to address, or a needed change that is identified. To assess the question, a literature search is performed and relevant literature is identified and appraised. The types of evidence used to inform practice can be scientific research (eg, randomized controlled trials, systematic reviews) or nonresearch evidence (eg, regulatory and accrediting agency requirements, professional association practice standards and guidelines, quality improvement project reports). The AORN recommended practices are a synthesis of related knowledge on a given topic, and the authorship process begins with a systematic review of the literature conducted in collaboration with a medical librarian. At least two appraisers independently evaluate the applicable literature for quality and strength by using the AORN Research Appraisal Tool and AORN Non-Research Appraisal Tool. To collectively appraise the evidence supporting particular practice recommendations, the AORN recommended practices authors have implemented a new evidence rating model that is appropriate for research and nonresearch literature and that is relevant to the perioperative setting.

Developing effective drills in preparation for a malignant hyperthermia crisis.

A malignant hyperthermia (MH) crisis is a medical emergency. To give the patient the best possible chance for a successful outcome, a swift, coordinated, multidisciplinary team response is necessary. Malignant hyperthermia occurs infrequently and, as such, details about its diagnosis, treatment, and management must be reviewed and reinforced during periodic education sessions. An MH response plan should be developed to guide a multidisciplinary team during an MH crisis. This plan should be tailored to the needs of the individual health care organization and practiced and refined during periodic simulations of MH episodes, such as MH mock drills.

Implementing AORN recommended practices for hand hygiene.

This article focuses on implementing the revised AORN "Recommended practices for hand hygiene in the perioperative setting." The content of the document has been expanded and reorganized from the previous iteration and now includes specific activity statements about water temperature, water and soap dispensing controls, the type of dispensers to use, paper towel dispenser requirements, placement of soap and rub dispensers, and regulatory requirements for products and recommendations for hand hygiene practices. A successful hand hygiene program allows end users to have input into the selection and evaluation of products and should include educating personnel about proper hand hygiene, product composition and safety, and how and when to use specific products. Measures for competency evaluation and compliance monitoring include observations, quizzes, skills labs, electronic monitoring systems, handheld device applications, and data collection forms.

Implementing AORN recommended practices for prevention of deep vein thrombosis.

One to two people per 1,000 are affected by deep vein thrombosis (DVT) or pulmonary embolism in the United States each year. AORN published its new "Recommended practices for prevention of deep vein thrombosis" to guide perioperative RNs in establishing organization-wide protocols for DVT prevention. Strategies for successful implementation of the recommended practices include taking a multidisciplinary approach to protocol development, providing education and guidance for performing preoperative patient assessments and administering DVT prophylaxis, and having appropriate resources and the facility's policy and procedure for DVT prevention readily available in the practice setting. Hospital and ambulatory patient scenarios have been included as examples of appropriate execution of the recommended practices.

Implementing a research utilization plan for prevention of deep vein thrombosis.

Ensuring use of best practices is crucially important in today's health care system. Nurses can identify research results that offer promising new treatment options for their patients and should have a plan for implementing research findings. The perioperative education coordinator at one facility identified the occurrence of deep vein thrombosis as a significant problem. She conducted a literature review, created an education program for nurses, and implemented an evidence-based practice change. This article describes the steps in this process. Now, patients at the facility consistently are assessed for deep vein thrombosis and receive appropriate preventive treatment.