Periop Today

Helping periop nurses and teams grow, learn, and achieve.


Updated December 13, 2023

This edition of Periop Today looks different because AORN is undergoing a systems upgrade.

We’ll return to our usual format with the next issue on Jan. 3, 2024.

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Periop Today Supports Your Practice

Welcome to Periop Today! It's AORN’s bi-weekly digital newsletter for members. Keep current on AORN Guidelines updates. Learn clinical best practices. Discover new clinical resources. Find leadership and career advice. And never miss out on CNE CH articles, webinars, and periop conferences.

Critical Updates to 6 AORN Guidelines for 2024

Changes for 2024: Communication misses, medication errors, and unsafe ergonomics risk patient and team safety.
Check out these fixes from the latest revisions you'll find in the 2024 edition of Guidelines for Perioperative Practice.
Changing evidence often calls for a change in practice. That’s why teams and leaders need to review the new evidence together.
AORN will soon release the 2024 edition of Guidelines for Perioperative Practice, and six guidelines received an evidence refresh, including changes to:
  • Design and Maintenance of the Surgical Suite
  • Medication Safety
  • Manual High-Level Disinfection
  • A Safe Environment of Care
  • Team Communication
  • Safe Patient Handling and Movement
The number of changes this adds up to shouldn’t be overlooked, so we turned to Guidelines Editor-in-Chief Erin Kyle, DNP, RN, CNOR, NEA-BC, to break it down.

Top 3 Common Safety Errors to Fix

So, where to start? Kyle suggests teams tackle these top errors that are potential risks to patients and providers across all perioperative settings:
  1. Errors that could be mitigated with optimizing team communication.
  2. Medication errors and exposure to hazardous meds.
  3. Occupational injuries caused by unsafe movement.
Kyle recommended that teams and leaders:
  1. Establish a Culture of Safety to Optimize Team Communication
    Effective team communication practices are built on a foundation of a strong culture of safety.
Take a closer look at your safety culture with this evidence noted in the Team Communication guideline:
  • Review how a strong safety culture can lower the risk-adjusted rate of morbidity and mortality.
  • Distinguish between human errors and system errors to build a just culture as part of your safety culture. (See 1.7 in the guideline)
  • Work within an interdisciplinary team to create (or improve) your standardized hand-off and briefing processes. (See 2.2 and 3.2 in the guideline).
  • Read why a standardized Surgical Safety Checklist can stop communication-related errors and omissions. (See 6.1 in the guideline)
  • Make sure to use a structured framework to implement your checklist. (See Table 1 in the guideline)
  1. Mitigate Medication Errors and Exposures
    Medication errors are 100% preventable but continue to occur. This is despite safety regulations, standards, and guidelines.
To change this, gather your interdisciplinary team and strategize with this evidence in the Medication Safety guideline:
  • Consider how to handle medication shortages. Plan ahead for supply chain interruptions and need surges. (See 1.8 in the guideline)
  • Electronic preference lists and protocols can support streamlined and standardized medication ordering processes, but they need to meet the requirements to be standing orders. They also need to be well constructed and reviewed regularly. (See 4.4 in the guideline)
  • Antineoplastic medications and other hazardous drugs are contaminating ORs and exposing staff to carcinogens. (See Tables 1 and 2 in the guideline)
  • Sample surfaces after cleaning for procedures using hazardous meds to catch residual contamination. (See 12.19 in the guideline for how to do this)
  1. Prevent On-The-Job Strains and Patient Injuries
    Stop powering through physically taxing activities such as manual lifting and carrying heavy instruments. These activities create lifelong injuries that cut nursing careers short and risk patient falls.
Make sure these safe patient handling and movement practices are part of your safety culture, as described in the Safe Patient Handling and Movement (SPHM) guideline:
  • Review the evidence on chronic musculoskeletal injuries for OR professionals. (See introduction and 1.1 in the guideline)
  • Incorporate the principles of SPHM into policies and procedures.
  • Identify tasks that place team members at higher risk for injury. (See 2.3 in the guideline)
  • Use ergonomic tools to set healthy boundaries. (See ergonomic tool figures and review 5.1 in the guideline)
Key Takeaways Help Track Evidence Updates
Thankfully, the old days of having to seek out changes in each guideline are behind us, Kyle says. That’s because the guidelines’ Key Takeaways are created to identify new content and important points to reinforce the learnings.
If your facility subscribes to eGuidelines+ you can find the latest Key Takeaways by guideline topic. If you use the print book, look for Key Takeaway at the beginning of each guideline.
Pre-order Today & Save (Prices Increase January 1, 2024).
Equip your team with the most current information to apply evidence-based practice and support optimal patient outcomes. Pre-order the 2024 edition of the AORN Guidelines for Perioperative Practice now to ensure you have these critical updates.
Your order of either the print book or eBook will be fulfilled in January 2024. The eBook can be viewed on web browsers – printing & pdf downloads are not available from the eBook.

A Season of Gratitude: What a Little Kindness Can Do

How periop RNs create impactful moments of kindness and compassion in the OR.
During the holidays, expressing gratitude and showing appreciation takes on a special significance. Periop Today asked periop nurses across the country what makes a difference to them.
In a season marked by reflection and goodwill, showing gratitude not only strengthens relationships but also contributes to the overall spirit of generosity and compassion. It serves as a reminder of the value we place on the people in our lives and the shared experiences that make the holiday season truly special.
Here’s what periop nurses had to say about acts and words of kindness that have made a difference in their lives and the lives of others:
Sheryl E. — Being a nurse has always made me feel special and appreciated...a few times in my career, I have had the privilege of caring for a homeless or neglected elderly Veteran who was very much down on his luck. Cleaning them up before surgery, making eye contact, and communicating compassionately with someone that people don't want to look at is amazingly powerful.
Michele H. — I give gifts to our Surg Techs at the holidays. Usually, it’s a little bag with a gift card and a bit of candy in it with a note from me. They don’t get enough appreciation, and they’re usually cleaning up nasty messes. I also feel appreciated when the anesthesiologists recognize that I am a valuable member of the team and know what I’m talking about, and when they sometimes use something I have said or done as an example for an SRNA to learn from.
Alexis C. — For the housekeepers, I would always make them cupcakes for every holiday to show my appreciation for them turning my rooms over so quickly. They don’t get enough praise.
For patients, I am very up front with them about the process and what I do in the OR. I tell them I’ll be there the whole time, and I ask if I can contact family with updates then explain the frequency. The gratitude they bring to me to be there for them during a challenging/scary time in their life is humbling. I love being able to help make their experience smooth for a procedure they have been waiting months or years for... they are always so happy/ready to have the surgery done. Excluding trauma...
Lindy B. — I love to send handwritten notes of gratitude, praise, and recognition to my team for special events like OR RN, ST week, etc. But more importantly, randomly, whenever I notice it, someone tells me about someone who has gone over and above to provide care. Or the unsung team member who exemplifies teamwork without expecting anything.
Dawn PS — When surgeons ask you to do their cases… it shows they appreciate us.
Kristen J. — I had a patient yesterday whose wife asked if his right hand could be uncovered during the case so the Lord could hold it… You better believe I made sure that happened!
Bethany F. — I'm a new nurse, so when someone tells me “good job today," I'm pretty happy. Our facility gives "bravos" so you can go online and write something about others and they get a $2 coupon to use for food, or coffee in the hospital.
Jamie M. — I am grateful when other nurses who are free check in on the ones in rooms. Especially late in the day when help is limited.
Ali M. — Most surgeons don’t [ask], so the couple of surgeons who ask us if we’re satisfied with the patient positioning/padding, etc., before they go scrub in makes me feel valued. It’s nice to see them ask for our input and recognize we may be more knowledgeable than them about some things versus just acting like we are only there to support them and fetch things.
Valentina P. — Every time my patients asked me, “are you going to be with me the whole time?”and I say, “yes!”
All of a sudden, they feel safe and grateful. But they just met me. Then I know this is my mission in life. If somehow, I can make them feel safe in such a vulnerable moment in their life, I am happy to be here for them. And I will be their advocate the whole time.
It is such a pleasure to be that person for them. Even though we may not see each other again. I just always wish them well and speedy recovery.
And hopefully all we did in the OR make their lives better.
Theresa M. — We have a candy jar at work and several staff and surgeons donate bags of candy/ chocolate to share with everyone – a quick picker upper!
Robert L. — The words, “Thank You” from the surgeon, after every case. As an OR nurse for many years, they have lots to say, (e.g., delays, equipment, room turnover) to be appreciated is such an important part of OR nursing.
Kelley W. — There was a language barrier with a PACU patient who was having cyclical post-op vomiting. Pain was managed. Nausea meds pushed, old fashioned alcohol wipe on the nose, vitals still above 20% baseline. I just pulled her close to me and she fell asleep on my shoulder for a few minutes – vitals stabilized, Emesis ceased.
Did it take an extra 10 minutes of universal kindness? Yes. Did the patient have a good outcome? Yes.
I couldn’t speak her language nor her mine – but a hand, soft voice, a shoulder, forehead rub – sometimes is the universal language of “I got you“… there is no med to replace that … if there’s downtime between cases, help your MA’s and nurses, make those call backs, stock and fill the bays for the next nurse behind you to ensure patient care.
Anonymous — When I was on the ortho team, I was assigned one day to work with an ENT surgeon who was very particular. I told him I had never participated in his procedures before, but I knew how to read a preference card. After the case, he told me I did a great job, and then “sang my praises” to the manager.
He told them I did a better job than his own team and he’d like me in his room any time. Well, that was nice, but it didn't go over so well with his team... although they didn’t like working with him. They came and asked me what I had done... I said, "I read the preference card and followed it." I thought it was funny and I got to work with him a lot.

Thank you to those who contributed to this article and to the incredible nurses who care for and keep patients safe every day of the year. Happy holidays from AORN.
(Some of these messages were edited for clarity and length.)

CMS Hands ASCs Big Victories for 2024

Several surgical codes were added to the CMS ASC-approved list that are sure to fuel the growth of ambulatory surgery centers.
The Centers for Medicare & Medicaid Services (CMS) reversed course and has approved total shoulder replacements and several other procedures to be reimbursed when performed at ambulatory surgery centers.
CMS added 11 CPT codes to its ASC-approved list.

Four Ways to Gain Confidence in the OR

Boost your confidence in the OR with four essential strategies.
Learn how knowing your resources, speaking up, effective communication, and staying organized can transform your performance and patient care.
Follow our tips to develop the confidence you need as an RN circulator in an OR full of surgeons and support staff.

3 Methods to Nurture Relationships with Spanish-Speaking Patients

What do you do when language is a barrier?
Enhance your care for Spanish-speaking patients with three effective methods. Learn simple yet impactful strategies (tailored for periop RNs) to build trust and improve communication in the OR, tailored for perioperative nurses.

Eliminate Formalin Exposure & Spills

UltraSAFE automatically dispenses formalin, protecting you from formalin fumes and eliminating the potential for spills.
Sponsored by Milestone Medical

Save Time Searching for Missing Sponges

A hectic OR, combined with multitasking, can result in incorrect counts of surgical sponges. Stryker's SurgiCount+ is designed to help safeguard your workflow and verify sponge removal.
Sponsored by Stryker Surgical Technologies

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