Abstract: Nicholson, Patricia In a landmark publication, 'To Err is Human', experts estimate that as many as 98 000 patients die each year from medical errors, highlighting patient safety as a key area for improvement in health care. This is reinforced in the National Safety and Quality Health Services Standards. Correct patient positioning is a critical part of any surgical procedure yet is often overlooked despite the risk of iatrogenic injuries that are reported as a result of improper positioning. Incorrect patient positioning can have a profound effect on patients, causing postoperative distress and increased morbidity, with nerve injuries the second most common litigation of all anaesthesia-related medico-legal claims reported, according to the ASA Closed Claims Project database.
Abstract: Asdornwised, Usavadee; Pipatkulchai, Daranee; Damnin, Suwat; Chinswangwatanakul, Vitoon; Boonsripitayanon, Mongkol; Tonklai, Sununtha Evidence-based guidelines for the management of surgical smoke and bioaerosols for perioperative nurses are necessary to improve the quality of care for patients and to ensure a safe environment in operating rooms. A survey of 377 operating room (OR) nurses throughout Thailand was used to assess the incidence of health problems related to surgical smoke exposure, as well as the current practices for these substances. A high percentage of OR nurses reported little or no use of smoke evacuation tools such as central smoke evacuation systems (100 per cent), portable smoke evacuation units (82 per cent), wall suction with inline filters (56.5 per cent) or laparoscopic evacuation/ filtration systems (63.7 per cent) during surgery. Most of the perioperative nurses suffered from headaches and/or sore throats. Due to the wide range of deleterious health issues that arise from exposure to surgical smoke, it is critical that perioperative nurses closely adhere to best practice guidelines for minimising this environmental hazard.
Abstract: Bingham, Sharon; Walsh, Kenneth; Ford, Karen An estimated 234 million operations are performed in hospitals each year and complications of surgery are common and often preventable. The rates of complications vary between studies with reports of perioperative death rates of between 0.4 and 0.8 per cent and rates of complications between 3 and 17 percent. Adverse events can lead to patient disability, death, or increased length of stay, imposing a significant burden on the health care system, patients and their families.
Abstract: Wozniak, Beth Innovation, literally, means 'the introduction of something new'. However, the term implies an improvement or change for the better and innovation is important in the medical sector particularly in the field of nursing where so many challenging issues are present. In this article, Beth Wozniak shares her experience of innovation the trials, tribulations and victories on her journey from seeing a need as a graduate nurse to seeing the software system she developed being used in hospitals.
Abstract: The conference program is shaping up to be one of the best with National Standards workshops on the Wednesday followed on Thursday, Friday and Saturday by a plethora of noted plenary and keynote presenters and high quality presentations.
Abstract: Wakefield, Erin The term 'transition shock' is a relatively new concept used to describe the experience of moving from the comfortable and familiar role of the preregistration nursing student to the professional registered nurse (RN). The initial and most dramatic stage in this theory of role adaption occurs over the first four months of professional practice.
Abstract: Watson, Jessica Temperature management within the perioperative environment is an imperative component of and a standard of practice in providing effective patient safety and comfort. This literature review will explore the evidence surrounding the use of active and passive warming mechanisms in the prevention of postoperative hypothermia. Many studies have recognised the adverse consequences of inadvertent postoperative hypothermia, hence the rapid advancement in education about and use of equipment and devices for its prevention. Evidence-based literature was reviewed to provide rationales and recommendations for strategies to prevent postoperative hypothermia. This literature review will potentially guide clinicians through the use of effective devices to allow for informed choices to provide appropriate patient care.
Abstract: Hains, Toni; Turner, Catherine; Strand, Haakan The lines of demarcation between health care professionals were once clear. Gender, education and the ability to prescribe have historically differentiated doctors and nurses. Privileges of medical practice protected by legislation and insurance reimbursement are no longer the sole domain of the medical doctor. A need for 'non-physician practitioners' to meet changes in the health care environment has contributed to less defined lines of demarcation between health care professionals' roles. In the light of alterations to the context of health care and availability of resources, registered nurses (RNs) and allied health professionals are acknowledged as an under-used asset for safe and cost effective health care delivery. Task transfer does not dilute medical care but does strengthen health care.
Abstract: Aleman-Ortega, Heidi; Lee, Rebecca; Shambo, Lyda; Czinn, Edward Epidural or spinal anaesthesia-related infections cause serious and devastating morbidity and mortality. The possible infectious complications of neuraxial anaesthesia have become better understood in the past ten years. We assessed information from published case series, studies, randomised controlled trials and retrospective cohort studies to determine the rate of neuraxial infection and to evaluate iatrogenic causes of infection. The use of sterile gowning appears to be a factor associated with the decreased infection rates noted in some studies. A review of the literature demonstrated that personnel in interdisciplinary specialties use gowns for invasive procedures to prevent infection, and national and international multidisciplinary health care professionals appear to be increasing their use of sterile gowning to prevent infections. We undertook this literature review to explore the incidence of neuraxial infection, provide additional insight into multidisciplinary standards and evaluate whether the use of sterile gowns while performing neuraxial anaesthesia decreases infection rates.
Abstract: Osborne, Sonya Perioperative nursing practice is subject to a number of influences. Some of the significant influences include: the changing shape of Australia's patient and workforce demographics, the shifting boundaries of the environment where the patient undergoes surgical or invasive procedures, innovations in surgical technique and advances in surgical technology. Influences on our practice are constant despite the changing nature of those influences. This requires a constant response to duty of care on our part. The discourse around the need for quality and safety is centred on research and evidence-based practice.
Abstract: Foran, Paula We have been fortunate enough to commence a new stream of webinars where ACORN have joined with some of our trade partners to provide another dimension of education for you, our members. We will continue our Standards webinars and Education webinars but they are now joined by our Trade Partner webinars. The first of these webinars was with one of our oldest trade partners Ansell, a family name in operating suites in Australia. We thank Ansell most sincerely for being the 'first cab off the rank', sponsoring a webinar 'Understanding occupational latex and chemical allergies'. I'm sure you will join me in looking forward to enjoying this type of webinar every few months.
Abstract: Davies, Menna Next time you open an instrument tray or unwrap a sterilised item, consider the process the item has been through to arrive in the operating theatre.
Abstract: Stankiewicz, Monica; Wyland, Michele The use of antiseptics in theatre is mainstay treatment in reducing cutaneous bioburden and, in turn, preventing surgical site infection and sepsis. Typically, aqueous betadine and chlorhexidine in alcohol are preferred. Aqueous betadine is a broad-spectrum antiseptic with a quick kill rate but is deactivated by organic material on the patient's skin. More effective than aqueous betadine is chlorhexidine gluconate - it is also a broad-spectrum antiseptic but is not deactivated by organic compounds on the patient's skin.
Abstract: Tan, Eunice; Russell, Kylie Every year thousands of health care professionals worldwide are exposed to surgical smoke. There is evidence that this smoke consists of toxic gases, pathogens and particulate matter that is a hazard for patients and the perioperative team. Past research indicates that perioperative staff inconsistently comply with smoke evacuation recommendations. The aim of this study was to identify, review and discuss the issues related to surgical plume and its implications for patients and perioperative staff. The findings of this review relate to: surgical smoke content, its risks to the health of the perioperative staff, preventative measures, infection control measures, compliance with smoke evacuation systems, staff knowledge and barriers to implementing smoke evacuation practices. Of particular importance, the literature indicated that strong support from management and the implementation of regular staff education could improve practice for the management of surgical plume in the operating theatre.
Abstract: Watson, Donna S Henrik Kehlet, MD, PhD, a former professor of perioperative therapy and head of the Section for Surgical Pathophysiology at the Rigshospitalet in Copenhagen, Denmark, introduced concepts for Enhanced Recovery After Surgery (ERAS) programs in the mid-1990s. Dr Kehlet stated, 'the key question in our understanding of the pathogenesis of postoperative morbidity is ... related to the pathophysiological role of the various components of the surgical stress response and whether or not a modification of such responses may improve surgical outcomes'. Dr Kehlet challenged traditional standards of care for the patient undergoing colorectal surgery to better understand why a patient could have an unexpected poor outcome when surgery was uneventful and technically proficient. Dr Kehlet shifted patient care management from traditional care ('the way we have always done it') to assessing and modifying various interventions during the perioperative period with the intent of improving patient outcomes. The initial ERAS protocol introduced for patients undergoing colorectal surgery has been adopted in other surgical specialties and successfully implemented in Europe for more than a decade.
Abstract: Forsberg, Angelica; Vikman, Irene; Walivaara, Britt-Marie; Engstrom, Asa Purpose: To describe patients' perceptions of quality of care during the perioperative period and to identify areas for quality improvement.
Design: A cross-sectional descriptive survey design was used.
Method: The data was collected (N=170) using a questionnaire for perioperative care. The methods were descriptive statistics, reported as percentages, and a manifest content analysis of the free text.
Finding: The areas identified for improvement were information and participation. The participants lacked knowledge, preferred to hand over decision making to the hospital staff, and indicated that having personalised information about the surgery and perioperative period was important. However, too detailed information before surgery could cause increased anxiety.
Conclusions: This study indicates that participation and information needs in perioperative settings seem to be situation specific. In addition, these needs seem to be personal and surgery specific. Further studies are required to clarify the differences in the satisfaction and quality of care between groups of patients in the perioperative context.
Abstract: Meeusen, Vera; Mangnus, Carla; Masters, Samantha In the Netherlands, an individual with or without a nursing background can enrol in a nurse anaesthetist or theatre nurse program. Admission to the program requires either a secondary school diploma with a specialisation in physics and health, or a nursing degree. At the end of the study, the Dutch anaesthetic nurse is comparable to a nurse anaesthetist in other countries while theatre nurses are similar in scope of practice to scrub/scout nurses in other European countries. Retention of students is challenging, with an attrition rate of around 24 per cent adding to the cost for hospitals delivering the program1. Identifying ways to improve the efficiency of program delivery through enhanced student retention is a key priority for hospitals delivering this program. In this study, a longitudinal survey design was used to investigate student perceptions of their locus of control, a concept which is linked with motivation, persistence and achievement in study and work. Data was collected from a sample of 100 students over a five-year period in the Netherlands.
Abstract: Melville, Ruth IFPN continues to represent perioperative nursing groups worldwide. It is through this affiliation of perioperative nursing groups that our profession continues to be connected. Despite our cultural differences, we all share the common goals of safe and competent perioperative care for our patients, delivered by dedicated nurses within our profession.
Abstract: Rowland, Wendy Membership to ACORN is multifaceted. It relies on the local associations and the commitment of their volunteer network to deliver local and relevant professional education and networking opportunities.
Abstract: Foran, Paula In May I was fortunate to attend the European Operating Room Nurses Association (EORNA) conference in Greece. It was fantastic to hear presentations from all over the globe and to realise that, despite our distance, we share many common goals and challenges with our international perioperative nursing colleagues.
Abstract: Hains, Toni; Turner, Catherine; Strand, Haakan In Australia, the role of the Non-Medical Surgical Assistant (NMSA) lacks recognition and professional regulation. This paper reports the findings of a recent survey of Australian perioperative staff [n=116] to determine their knowledge and perceptions of the NMSA role. The survey findings confirm that the role is not well established across the Australian health care system. Of concern is that perioperative staff are required to fill the role of surgical assistant on an impromptu basis. NMSAs with no post-graduate qualifications are perceived by perioperative staff to be less equipped in mentoring, leadership, theatre efficiency, safety and procedural knowledge. There was evidence that some perioperative praxes necessitate the role of the NMSA to avoid practices that compromise patient safety.
Abstract: Derieg, Sarah Care of paediatric surgical patients is not limited to paediatric facilities, and all perioperative RNs should have a basic understanding of the specialised care that children require. This knowledge set includes an understanding of the basic terminology used to describe this patient population as well as the developmental stages of paediatric patients. Preoperatively, the nurse should conduct a thorough assessment and evaluation and address the anxieties and questions of the patient and his or her parent or guardian. Intraoperatively, the nurse should be prepared to help manage difficult intubation, laryngospasm during induction and extubation, difficult IV access, positioning, skin care, surgical site preparation and thermoregulation. Postoperative care considerations include addressing airway differences, vital signs, pain assessment and management, fluid management and preparation for discharge. Awareness of the anatomic and physiological differences, developmental stages and surgical needs of children will allow the perioperative RN to provide high-quality, safe care to the paediatric surgical patient.
Abstract: Liu, Liang Qin This systematic review aimed to critically appraise and synthesise updated evidence regarding the effect of surgical scrub techniques on skin integrity and the incidence of surgical site infections.
Abstract: Hains, Toni; Strand, Haakan; Turner, Catherine The term Non-Medical Surgical Assistant (NMSA) is not widely acknowledged in Australia but is used to describe the role of clinicians without a medical degree or qualification who provide clinical services during the perioperative phase of a patient's journey. The role of NMSA has many configurations internationally and not all NMSA roles arise from a nursing platform. To date, the implementation of many Advanced Practice Nurse (APN) roles have lacked educational support or professional direction. The literature supports the standardisation of APN roles where they are regulated by the profession and attained through an appropriate tertiary level qualification. In this paper, we review characteristics of the roles of the NMSAs in the United States of America, Canada, the United Kingdom and New Zealand, countries that have similar standards for practice to Australia and provide a similar standard of health care. We will discuss implications for perioperative nurses and make recommendations for a future approach which formalises the role of the NMSA for the Australian context.
Abstract: Cooney, Maureen F One of the most challenging aspects of acute pain management is the management of pain in patients who are opioid tolerant, whether tolerant from opioids prescribed for chronic pain or from opioid use related to addiction.
Abstract: Gilbert, Julia; Gillespie, Brigid M At law, adults are presumed to have legal competency to provide consent for or refusal to consent to health care treatments unless they have cognitive impairment. But what of the adolescent who is, at law, a child but who refuses to undergo elective surgical treatment' This paper discusses the issues surrounding the case of Keith, a 14-year-old boy with ulcerative colitis, who refuses consent to undergo an elective ileostomy.
Abstract: Davies, Menna On entering any present-day operating theatre donning 'scrubs', cap, shoes, mask and protective eye wear are actions we take for granted. However, have you ever stopped to consider how we arrived at a time when donning our attire has become such a natural activity' This article uses a series of images to examine the evolution of operating theatre attire.
Abstract: Foran, Paula As you may all be aware, the Education, Research and Journal (ERJ) Committee has been restructured with three subcommittees: Journal; Hospital and University Collaboration and Accreditation (HUCA) and Grants, Awards and Scholarships (GAS).
Abstract: Levada, Lilliana; Osborne, Sonya The patient has the right to an infection-free perioperative journey, without suboptimal outcomes or poor experiences.
Abstract: Gore, Amanda; Osborne, Sonya Posthumous organ procurement is a critical procedure in which perioperative nurses contribute significantly to the conduct of the procedure and viability of organs and tissues for later transplant. The rate of organ donation has increased over 70 per cent in recent years, which saw, in 2016, a record 1440 Australians receiving transplants as a result of 503 deceased organ donors'. However the rate of donation in Australia is still relatively low compared to other nations, and occurs so sporadically in most operating rooms that it is difficult to acquire expertise as a perioperative nurse.
Abstract: Sutherland-Fraser, Sally Perioperative nurse, Sally Sutherland-Fraser, has also studied fine arts. In this column, she draws on both disciplines to reveal the history behind an intriguing photograph of surgery from World War One.
Abstract: Gilbert, Julia; Gillespie, Brigid M At law, all individuals are presumed to have the legal capacity to provide consent or refusal of treatment unless there are clinical indications of cognitive impairment. Once concerns are raised regarding the ability of an individual to provide valid consent for a surgical procedure, the use of a substitute decision-maker may be necessary. In this paper, we present an analysis of a clinical case study to illustrate the principles of valid consent. As part of the analysis, we discuss the issues relating to obtaining valid consent for an operative surgical procedure from an elderly client with obvious cognitive impairment. We also explore the role of a substitute decision-maker to obtain the requisite valid consent.
Abstract: Gill, Arron; Randell, Rebecca Effective teamwork in the operating theatre is important for safe patient care. In robotic surgery, the surgeon is physically separated from the operating theatre team, which could potentially have an impact on teamwork. With robotic surgery increasing internationally, this article reviews relevant published literature on teamwork in the operating theatre and reflects on how this might be impacted by robotic surgery. We conclude by describing a research study we are currently undertaking on this topic.
Abstract: Mangham, Mandy Safe, patient-centred care is a large part of our trust values at the Royal Wolverhampton NHS Trust. Robotic assisted laparoscopic surgery (RALS) is still in its infancy within our trust, and we decided to look at what we have learned so far regarding patient positioning during robotic surgery for gynae-oncology and uro-gynae procedures. We also considered what we believe needs to be achieved in order to deliver high standards of care in positioning patients during robotic surgery, not only now, but also for the future of robotic surgery.
Abstract: Kynoch, Kate; Crowe, Linda; McArdle, Annie; Munday, Judy; Cabilan, CJ; Hines, Sonia Perioperative nurses recognise that family members experience increased levels of anxiety during the wait for a relative undergoing a surgical procedure. It is often during this time that little or no meaningful communication occurs between family members and health professionals. It has been suggested that a structured information intervention has the potential to increase communication between families and health care professionals as well as decrease family members' anxiety.
Abstract: Freeling, Michelle; Parker, Steve; Breaden, Katrina While the new graduate nurse journey has been well documented, little research exists from the perspective of the experienced nurse, particularly in the perioperative environment. Barriers to graduate nurse support need to be understood, as job satisfaction, nurse wellbeing and quality of patient care can be negatively affected.
Abstract: Davies, Menna; Sutherland-Fraser, Sally; Mamea, Natasha; Raddie, Nerrie; Taoi, Mabel Hazelman This article is the second in a series that describes the a collaborative project between Australia and the Pacific Island countries (PICs) to develop and implement a set of infection prevention standards which are context-specific to 'limited resource settings', such as those found in PICs.
Abstract: Foran, Paula Another busy few months for ACORN education. You will have all enjoyed perioperative nurses' week. Congratulations to all perioperative nurses for all the great work we do.
Abstract: Wilson, Seri With nearly 40 per cent of Australian nurses aged 50 or over, baby boomer nurses' retirement may have significant impact on the nursing workforce. We hear so much about new graduates having trouble getting into the workforce but we rarely hear about nurses thinking of leaving. So what are baby boomer nurses thinking about their retirement plans'
Abstract: Russell, Kylie; Coventry, Tracey A key expectation from the health care industry in Australia is that nurses engaged in postgraduate specialist education need to be able to apply their extended knowledge and skills to the workplace. For this to succeed, health services need to be involved in the development of course content and learning outcomes to ensure authentic engagement. Essential to this is student participation in workplace learning that provides experience, performance feedback and reflection. This promotes graduate success to meet industry expectations.
Abstract: Battie, Renae The American Nurses Association (ANA) code of ethics states that the definition of accountability is 'to be answerable to oneself and others for one's own actions'. As perioperative nurses, we are accountable to our patients and their family members, our colleagues, our workplace and our profession. Because of this, perioperative nurses should hold themselves accountable for patient advocacy, continuity of care and lifelong learning, and to colleagues, the nursing profession and their organisation.
Abstract: Holmes, Stephanie Despite the acknowledgement of the hazards of surgical plume, compliance with smoke evacuation is not routine.
This review examines the current literature on factors influencing compliance with smoke evacuation. Factors identified included the design of the smoke evacuation device, surgeon refusal, education and managerial support. Strong leadership, education and policy enforcement from a local facility level are required to improve surgical plume evacuation compliance. More research in this field would help to further strengthen these findings.
Abstract: Karam, May The operating room! It is a closed world with a large sign posted 'no entry'. For many it is mysterious, secret, hard, cold, hostile.
Abstract: Steward, Coralie Once in a while, something happens to us that makes us question our faith in the caring ethos which is so integral to our role as clinicians.
Abstract: Criscitelli, Theresa Health care is a technologically driven profession that is rapidly evolving. Technology is thought to improve outcomes, but data shows an increase in health care errors, some of which are technology related.
Abstract: Unac, Fiona; Rolls, Suzanne Nurses who assist anaesthetists are being squeezed out of the role, despite a workforce shortage. What's happening'
Abstract: Jensen, Joy In the months leading up to the conclusion of my term as the Honorary Treasurer on 11 November 2016, I wondered what governance meant to our predecessors, those charged with governing ACORN 40 years ago and in the years since. I have concluded that they must have done a sterling job, given that we are financially strong and performing well four decades on. The recent change to the ACORN constitution eliminated the role of Honorary Treasurer and I write this article to provide members with knowledge about how ACORN is governed and confidence that our College remains in good hands.
Abstract: McGarry, Jon R This paper presents the management of a woman undergoing her fifth caesarean section in the presence of a placenta percreta. It reviews the incidence and surgical management of this complex pathology. Advanced planning and multidisciplinary coordination is crucial to successful treatment of this condition. There are implications for theatre staff of all professions to be confident and familiar with specialist equipment. Such cases represent a trend of multidisciplinary working that is increasingly part of current practice.
Abstract: Anderson, Rick Reading a recent article in 'The Atlantic' and the subsequent comments, I was struck again by how much confusion there is among the public about the difference between plagiarism and copyright infringement.
Abstract: Baker, Joy Don Perioperative nurse authors should strive to have their scholarly works published in a journal that adheres to high ethical standards, focuses on the readers' needs, and provides the opportunity for authors to disseminate their works effectively.
Abstract: Goudas, Lauren Open Heart International is a volunteer-driven organisation that provides a range of medical treatments to thousands of people in developing countries and also helps to train local practitioners in providing surgery themselves.
Abstract: Greene-Golden, Sharon In January 2014, 18 patients in a North Carolina hospital were exposed to surgical instruments used on a patient who was later confirmed as having Creutzfeldt-Jakob disease (CJD), a rare, degenerative, rapidly progressing, fatal neurological disorder that affects approximately one in every one million people worldwide per year.
Abstract: Spruce, Lisa A surgical site infection (SSI) is an unintended and oftentimes preventable consequence of surgery. There is a significant amount of literature related to preventing SSIs, and it is up to practitioners in each care setting to review the evidence and work together to implement SSI prevention measures, such as nasal decolonisation, antibiotic prophylaxis, preoperative showers, preoperative oxygen supplementation, and antimicrobial sutures. In addition, practitioners can follow several recommendations to reduce the risk of SSIs, including following proper hand hygiene practices; wearing clean, facility-laundered scrub attire; following a surgical safety checklist and speaking up when a break in sterile technique is witnessed. The benefits of preventing SSIs are preventing patient mortality and decreasing the burden that SSIs pose on the national health care system. It is up to health care leaders to drive and support SSI prevention initiatives.
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