AORN journal
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Case Reports
Standardizing documentation for postoperative nausea and vomiting in the electronic health record.
Postoperative nausea and vomiting (PONV) remains a common postoperative complication that causes patient discomfort and increases health care costs. Clinicians use the American Society of PeriAnesthesia Nurses (ASPAN) guideline to help prevent and treat PONV. However, the lack of standardized terminology in the electronic health record (EHR) and the lack of clinical decision support tools make it difficult for clinicians to document guideline implementation and to determine the effects of nursing care on PONV. ⋯ This mapping results in a standardized dataset specific to PONV for use in an EHR, which links nursing care to nursing diagnoses, interventions, and outcomes. The mapping and documentation in the EHR also allows standardized data collection for research, evaluation, and benchmarking, which makes perioperative nursing care of patients who are at risk for or experiencing PONV measureable and visible. Distributing this information to perioperative and perianesthesia nursing personnel, in addition to implementing risk assessment tools for PONV and clinical support alerts in electronic documentation systems, will help support implementation of the PONV clinical practice guideline in the EHR.
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The potential that forced-air warming systems may increase the risk of surgical site infections (SSIs) by acting as a vector or causing unwanted airflow disturbances is a concern to health care providers. To investigate this potential, we examined the literature to determine whether forced-air warming devices increase the risk of SSIs in patients undergoing general, vascular, or orthopedic surgical procedures. ⋯ All of the sources we examined contained methodological concerns, and the evidence did not conclusively suggest that the use of forced-air warming systems increases the risk of SSIs. Given the efficacy of these devices in preventing inadvertent perioperative hypothermia, practitioners should continue to use and clean forced-air warming systems according to the manufacturer's instructions until well-conducted, large-scale trials can further examine the issue.
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Although basic life support skills are not often needed in the surgical setting, it is crucial that surgical team members understand their roles and are ready to intervene swiftly and effectively if necessary. Ongoing education and training are key elements to equip surgical team members with the skills and knowledge they need to handle untimely and unexpected life-threatening scenarios in the perioperative setting. Regular emergency cardiopulmonary arrest skills education, including the use of checklists, and mock codes are ways to validate that team members understand their responsibilities and are competent to help if an arrest occurs in the OR. After a mock drill, a debriefing session can help team members discuss and critique their performances and improve their knowledge and mastery of skills.
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Stakeholders in the automotive industry, airline industry, and anesthesia profession have identified critical periods of time in which distractions and interruptions of normal processes can have devastating effects. Just as reducing distractions improves safety in an automobile or airplane cockpit, limiting distractions and interruptions during critical times in the perioperative setting can increase patient safety. ⋯ We also worked with our anesthesia partners to address their concerns about interruptions during the administration of nerve blocks. The perioperative nurses at our hospital initiated strategies to reduce distractions or interruptions to their practice at critical points, and, in collaboration with surgical committee members, we developed strategies to reduce or eliminate distractions for anesthesia professionals during the preoperative administration of nerve blocks and to eliminate distractions for the RN circulator and scrub person during the final counts.
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A code blue in the OR is a low-volume, high-risk event. To be effective during a code blue event, perioperative personnel must be able to properly execute a response plan and perform seldom-used skills and procedures. ⋯ One month after the educational experience, all team members passed an observed competency for responding to a code blue in a simulation laboratory. These results show the effectiveness of the educational experience as part of the code blue drills program in the hospital's main OR.