Falling Through the Crack (in the Bedrails)
A 65-year-old woman with cirrhosis presented to the hospital with septic shock and respiratory failure. Hospital staff members placed her on a mechanical ventilator, admitted her to the intensive care unit, and inserted a nasogastric tube to administer medications. The patient was disoriented, so the medical team administered a sedative and placed restraints on her wrists to prevent her from pulling out lines or tubes. She had ascites, so the medical team decided to perform paracentesis to rule out infection. (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Tags: Column Source Type: research

Educational Opportunities
Registration now open! Learn about the latest research, best practices, and innovative ideas coming out of the surgical suite at AORN ’s annual educational conference. This premier event offers a robust program with expert speakers, hands-on training, and hundreds of contact hours. Learning will extend beyond the classroom to the exhibit hall, which will have the latest perioperative trends, surgical products, and technologies. Plus, hear from poster presenters about breakthrough ideas, actions, and evidence-based research affecting perioperative nursing. (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Tags: Column Source Type: research

Results of the 2017 AORN Salary and Compensation Survey
AORN conducted its 15th annual compensation survey for perioperative nurses in June 2017. A  multiple regression model was used to examine how several variables, including job title, educational level, certification, experience, and geographic region, affect nurse compensation. Comparisons between the 2017 data and data from previous years are presented. The effects of other forms of comp ensation (eg, on-call compensation, overtime, bonuses, shift differentials, benefits) on base compensation rates are examined. (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Donald R. Bacon, Kim A. Stewart Tags: Special report Source Type: research

Operation Clean Air: Implementing a Surgical Smoke Evacuation Program
Surgical smoke is a hazardous byproduct of any surgery involving a laser or an electrosurgical unit. Although research and professional organizations identified surgical smoke as harmful many years ago, this byproduct continues to be a safety hazard in the OR. An interdisciplinary team at a large academic medical center sought to address the exposure of patients and perioperative team members to surgical smoke. The team used the nursing process to resolve the lack of smoke-evacuator equipment and surgical smoke staff member knowledge. (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Mary K. Dobbie, Maria Fezza, Martha Kent, Jane Lu, Mark L. Saraceni, Susan Titone Tags: Featured article Source Type: research

Minimizing Sources of Airborne, Aerosolized, and Contact Contaminants in the OR Environment
Surgical site infections are unintended consequences of surgery that can cause harm to patients and place financial burdens on health care organizations. Extrinsic factors in the OR —including health care providers’ behavior and practices that modify air movement, the physical environment, equipment, or surgical instruments—can increase microbial contamination. Microbes can be transported into the surgical incision by airborne or contact routes and contribute to a surgic al site infection. Simple practices to prevent infection—such as minimizing airborne particles and contaminants, maintaining ...
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Donna Armellino Tags: Featured article Source Type: research

Navigating Nursing Education
This article explores the various forms of nursing education and focuses on the types of degrees available, different practice roles and pathways, types of educational institutions and programs, and accreditation and its governing bodies. The benefits to nurses who pursue additional education include career mobility, additional responsibilities, and personal satisfaction. The benefits to patients include receiving the most current evidence-based care from a more highly educated and competent workforce. (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Rodney W. Hicks, Robert Patterson Tags: Featured article Source Type: research

Evaluation of a Brief Team Training Intervention in Surgery: A Mixed-Methods Study
The aim of this study was to evaluate a brief team training program in relation to teams ’ observed nontechnical skills (NTSs) in surgery, teams’ perceptions of safety culture, and the training implementation. We used mixed methods to analyze structured observations of 179 surgeries, semistructured interviews with surgical team members from four selected surgical specialties, and a survey. There were significant (P (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Brigid M. Gillespie, Catherine Steel, Evelyn Kang, Emma Harbeck, Kristina Nikolic, Nicole Fairweather, Wendy Chaboyer Tags: Featured article Source Type: research

Health Care Workers ’ Use and Cleaning of X-Ray Aprons and Thyroid Shields
We evaluated the use and cleaning of x-ray aprons and thyroid shields by surveying rural hospital system health care workers who wear x-ray aprons and thyroid shields. One hundred fifty-five of the 173 respondents were RNs (89.6%), and 94 respondents were from inpatient or outpatient surgical settings (54.3%). One hundred thirty-five respondents (78.0%) reported soiled x-ray aprons or thyroid shields, and 52 (30.1%) reported shield odors. Eighty-three participants (48.0%) indicated they never spot cleaned. (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Hope Honigsberg, Karen Gabel Speroni, Anna Fishback, Amy Stafford Tags: Featured article Source Type: research

Clinical Ethics: Patient and Provider Safety
Florence Nightingale said, “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm,”1 but perioperative nursing practice is indeed grounded in the ethical principles of beneficence and nonmaleficence. The AORN Perioperative Explications for the ANA Code of Ethics for Nurses2 and Guidelines for Perioperative Practice3 define the moral obligations inherent in the practice of perioperative nursing to promote patient and provider safety. (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Cecil A. King Tags: Column Source Type: research

Clinical Issues —December 2017
Bed bugsKey words: bed bugs, pest management, infestation, transmission.Warming irrigation fluidsKey words: irrigation fluid, warming fluid, hypothermia, warming cabinet.Fasting before surgeryKey words: fasting, NPO, liquids, solids.Advanced cardiac life support requirements for perioperative nursesKey words: advanced cardiac life support, ACLS certification, pediatric advanced life support, PALS certification, basic life support. (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Mary J. Ogg Tags: Column Source Type: research

Evidence appraisal of Erestam S, Haglind E, Bock D, Andersson AE, Angenete E. Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study.
Editor ’s note: Reading research and incorporating valid research results into practice is a vital part of ensuring that perioperative nursing practice is evidence based. The AORN Research Evidence Appraisal Tools can help perioperative nurses evaluate research. There are three tools for evaluation of th e different types of evidence: the Research Evidence Appraisal Tool–Study, the Research Evidence Appraisal Tool–Summary, and the Non-Research Evidence Appraisal Tool. These tools are used to evaluate the evidence upon which AORN’s guidelines are based. (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Nancy Girard Tags: Column Source Type: research

Embrace Action: Use Holidays to Strengthen Social Bonds
At this time of the year, our thoughts turn to the holidays. It is during these special days that we can strengthen our social bonds. These bonds represent the degree to which we assimilate into the society to which we belong. Travis Hirschi identified four bonds that promote conformity and socialization: attachment, belief, involvement, and commitment.1 His premise is that the stronger those bonds are, the less likely it is that delinquent behaviors will develop. A variety of holidays are recognized in December around the world (Sidebar 1) and present a wonderful opportunity for us to connect or bond with people in our co...
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Nathalie Walker Tags: Column Source Type: research

Partnering With Perioperative Colleagues to Prevent Infection
Surgical site infections (SSIs) continue to be a substantial cause of morbidity, lengthened hospital stays, and death despite advances in practices to control infection.1 In addition, the cost associated with each SSI “increases with the depth of the infection and can reach more than $30,000 per case for the more serious infections.”2 The risk of infection and its management may depend upon the location of the facility where the surgical procedure is performed. (Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: Dolores D. Suslak Tags: Column Source Type: research

Table of Contents
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Source Type: research

Editorial Board
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Source Type: research

Information for Readers
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Source Type: research

Guideline at a Glance: Energy-Generating Devices
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Authors: AORN Tags: Guideline at a glance Source Type: research

In This Issue
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Tags: AORN periop briefing Source Type: research

New guidance aims at improving communication during patient hand overs
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Tags: AORN periop briefing Source Type: research

News Briefs
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Tags: AORN periop briefing Source Type: research

Overcoming challenges related to cleaning, disinfection, and sterilization practices
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Tags: AORN periop briefing Source Type: research

Guideline for team communication
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Tags: AORN periop briefing Source Type: research

Open lobectomy
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Tags: AORN periop briefing Source Type: research

The rise of competency-based education
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Tags: AORN periop briefing Source Type: research

Did You Know?
(Source: AORN Journal)
Source: AORN Journal - November 22, 2017 Category: Nursing Tags: AORN periop briefing Source Type: research

Situational Awareness and Patient Safety
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Safety concerns in simulation-based training
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Modified radical mastectomy
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Guideline for medical device and product evaluation
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Celebrate Perioperative Nurse Week by taking time to focus on self-care
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Guideline at a Glance: Positioning
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Evidence appraisal of Yuwen P, Chen W, Lv H, et  al. Albumin and surgical site infection risk in orthopaedics: a meta-analysis.
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 Author(s): George Allen (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Clinical Issues —November 2017
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 Author(s): Esther M. Johnstone Heating, ventilation, and air-conditioning (HVAC) systems in the OR Key words: airborne contaminants, HVAC system, air pressure, air quality, temperature and humidity. Air changes and positive pressure Key words: air changes, positive pressure airflow, unidirectional airflow, outdoor air, recirculated air. Product selection Key word: product evaluation, product selection, selection committee. Entry into practice Key words: associate degree in nursing, bachelor of science in nursing, entry-level position, advanced educat...
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Enhancing Pediatric Perioperative Patient  Safety
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 Author(s): Quinn Johnson, Janette McVey (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Back to Basics: Environmental Cleaning Hazards
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 Author(s): Lisa Spruce Perioperative personnel must clean and disinfect the perioperative environment numerous times throughout the day to help prevent the risk of exposing patients to pathogenic microorganisms. However, this practice exposes perioperative team members to chemicals that could be harmful to their health. Exposure to cleaning and disinfecting products has been associated with potential health problems such as skin irritation, burns, rashes, and difficulty breathing. This Back to Basics article offers strategies for perioperat...
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Temporary Perioperative Tobacco Cessation: A Literature Review
We examined the literature from June 1989 to July 2017 regarding various tobacco cessation time frames for perioperative patients, searching MEDLINE, the Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Collaboration, and various online-only journals accessed through Google Scholar. We reviewed evidence from 15 studies that report wide variability in recommended time frames (eg, four to six months) for perioperative tobacco cessation. (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Epilepsy: Clinical Review and Surgical Options
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 Author(s): Beth Karasin, Mark Karasin Epilepsy is the fourth leading neurologic disorder in the United States and affects the quality of life of approximately 2.9 million Americans. Despite modern progress in medicine and technology, the disease may prove to be drug resistant, a condition that serves as a primary indication to consider invasive treatment modalities. Current evidence supports the efficacy of early surgical intervention for patients with drug-resistant epilepsy, although this approach continues to be underused. The positive outcom...
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Translating Evidence Into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best  Practice
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 Author(s): Jennifer L. Fencl, Candace Matthews Nursing is an information-intensive profession, requiring nurses to have high information literacy and the skills to find, understand, evaluate, and use information from a multitude of sources. The advanced practice RN (APRN) is a valuable resource to support and guide nurses in this effort. The APRN’s skills encompass understanding and implementing evidence-based practice, evaluating the organizational structure (eg, units, facilities, multisystem organizations) across the continuum of care, and f...
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Local Anesthetic Systemic Toxicity
This article provides the perioperative nurse with information about local anesthetics, the signs and symptoms of local anesthetic systemic toxicity, and the information needed to manage a patient experiencing this complication. (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

The Future of Certification: Beyond Contact Hours
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 Author(s): Juliana Mower (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Embrace Action: Celebrate Perioperative Nurse Week and Thanksgiving
Publication date: November 2017 Source:AORN Journal, Volume 106, Issue 5 Author(s): Nathalie Walker (Source: AORN Journal)
Source: AORN Journal - October 29, 2017 Category: Nursing Source Type: research

Situational Awareness and Patient Safety
A 40-year-old woman with a history of cirrhosis and known esophageal varices was admitted to the hospital with one day  of bloody stools. Medical team members started a blood transfusion and IV proton pump inhibitor therapy. Gastroenterology department staff members were consulted to assess and treat the source of her gastrointestinal bleeding. That same evening, a 50-year-old man with a history of antiphospholip id antibody syndrome complicated by recurrent blood clots and heparin-induced thrombocytopenia was admitted to the next room with a new pulmonary embolus. (Source: AORN Journal)
Source: AORN Journal - October 27, 2017 Category: Nursing Tags: Column Source Type: research

Educational Opportunities
Registration now open! Learn about the latest research, best practices, and innovative ideas coming out of the surgical suite at AORN ’s annual educational conference. This premier event offers a robust program with expert speakers, hands-on training, and hundreds of contact hours. Learning will extend beyond the classroom to the exhibit hall, which will have the latest perioperative trends, surgical products, and technologies. Plus, hear from poster presenters about breakthrough ideas, actions, and evidence-based research affecting perioperative nursing. (Source: AORN Journal)
Source: AORN Journal - October 27, 2017 Category: Nursing Tags: Column Source Type: research

Back to Basics: Environmental Cleaning Hazards
Perioperative personnel must clean and disinfect the perioperative environment numerous times throughout the day to help prevent the risk of exposing patients to pathogenic microorganisms. However, this practice exposes perioperative team members to chemicals that could be harmful to  their health. Exposure to cleaning and disinfecting products has been associated with potential health problems such as skin irritation, burns, rashes, and difficulty breathing. This Back to Basics article offers strategies for perioperative team members to implement to decrease their risk of ha rmful exposure to these pro...
Source: AORN Journal - October 27, 2017 Category: Nursing Authors: Lisa Spruce Tags: Featured article Source Type: research

Local Anesthetic Systemic Toxicity
Local anesthetics are commonly used in the perioperative environment to facilitate surgical procedures or to provide postoperative pain management for patients. The use of local anesthetics, however, introduces the risk of complications resulting from local anesthetic systemic toxicity and the  risks of increased morbidity and mortality for the surgical patient. Systemic toxicity from the injection or overdose of local anesthetics is a rare but potentially fatal complication that occurs in less than 1 in 1,000 patients. (Source: AORN Journal)
Source: AORN Journal - October 27, 2017 Category: Nursing Authors: Diana L. Wadlund Tags: Featured article Source Type: research

Temporary Perioperative Tobacco Cessation: A Literature Review
We examined the literature from June 1989 to July 2017 regarding various tobacco cessation time frames for perioperative patients, searching MEDLINE, the Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Collaboration, and various online-only journals accessed through Google Scholar. (Source: AORN Journal)
Source: AORN Journal - October 27, 2017 Category: Nursing Authors: Carol A. Devlin, Suzanne C. Smeltzer Tags: Featured article Source Type: research

Translating Evidence Into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best  Practice
Nursing is an information-intensive profession, requiring nurses to have high information literacy and the skills to find, understand, evaluate, and use information from a multitude of sources. The advanced practice RN (APRN) is a valuable resource to support and guide nurses in this effort. The APRN ’s skills encompass understanding and implementing evidence-based practice, evaluating the organizational structure (eg, units, facilities, multisystem organizations) across the continuum of care, and facilitating collaboration between perioperative nurses and other interprofessional team members to sustain practice chan...
Source: AORN Journal - October 27, 2017 Category: Nursing Authors: Jennifer L. Fencl, Candace Matthews Tags: Featured article Source Type: research

Epilepsy: Clinical Review and Surgical Options
Epilepsy is the fourth leading neurologic disorder in the United States and affects the quality of life of approximately 2.9 million Americans. Despite modern progress in medicine and technology, the disease may prove to be drug resistant, a condition that serves as a primary indication to consider invasive treatment modalities. Current evidence supports the efficacy of early surgical intervention for  patients with drug-resistant epilepsy, although this approach continues to be underused. The positive outcomes of epilepsy surgery are a result of multidisciplinary efforts, and perioperative nurses play a vital ro...
Source: AORN Journal - October 27, 2017 Category: Nursing Authors: Beth Karasin, Mark Karasin Tags: Featured article Source Type: research

Clinical Issues —November 2017
Heating, ventilation, and air-conditioning (HVAC) systems in the ORKey words: airborne contaminants, HVAC system, air pressure, air quality, temperature and humidity.Air changes and positive pressureKey words: air changes, positive pressure airflow, unidirectional airflow, outdoor air, recirculated air.Product selectionKey word: product evaluation, product selection, selection committee.Entry into practiceKey words: associate degree in nursing, bachelor of science in nursing, entry-level position, advanced education, BSN-prepared RNs. (Source: AORN Journal)
Source: AORN Journal - October 27, 2017 Category: Nursing Authors: Esther M. Johnstone Tags: Column Source Type: research

The Future of Certification: Beyond Contact Hours
As the complexity of health care increases, employers and health care providers strive to demonstrate competent practice that will result in safe, efficient, equitable, timely, and patient-focused care to an increasingly savvy consumer public.1 To address this change in expectations, competency validation through certification and its traditional method of renewal through the accrual of contact hours is being expanded to include other measures of evaluating competent practice. (Source: AORN Journal)
Source: AORN Journal - October 27, 2017 Category: Nursing Authors: Juliana Mower Tags: Column Source Type: research