AORN journal
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Retention of a surgical item is a preventable event that can result in patient injury. AORN's "Recommended practices for prevention of retained surgical items" emphasizes the importance of using a multidisciplinary approach for prevention. ⋯ Perioperative leaders may consider the use of adjunct technologies such as bar-code scanning, radio-frequency detection, and radio-frequency identification. Ambulatory and hospital patient scenarios are included to exemplify appropriate strategies for preventing retained surgical items.
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During the 2007 meeting of the Child Health Corporation of America Operating Room Director's Forum, members identified two major discrepancies in surgical count policies among the member hospitals: variations for instrument counts in pediatrics and exceptions to radiographic verification when needle counts were incorrect. The group agreed to collaboratively develop a pediatric count policy based on directors' expertise and current literature to help improve count practices. ⋯ The project exemplifies a successful nurse-led, national group effort. The outcome is a policy that represents best practice in pediatrics and is a first step toward future opportunities to improve patient safety.
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Patient-controlled analgesia (PCA) is an effective treatment option for reducing pain, but PCA errors can be quite serious. Opioid analgesics are among the most effective pain relievers available, but all have contraindications and can have adverse effects, including respiratory depression and other effects on the central nervous system. ⋯ Errors associated with the PCA process have been documented in each phase of the medication-use process; therefore, practice improvements in prescribing, transcribing, dispensing, administering, and monitoring PCA may reduce the likelihood of errors. Perioperative nurses can make important contributions to safe PCA use by establishing standardized processes to help ensure positive patient outcomes in pain management.
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Validating existing count practices and reducing individual practice variance are necessary to decrease the risk for retained surgical items. A quality improvement project was undertaken at one large city hospital to identify best practice and eliminate variability in count practices. ⋯ Assessment of the policies and practices indicated that clinical practice requirements in the policies varied greatly, and there was a high degree of count practice variability among staff members. The facility OR manager and OR quality coordinator collaborated with staff nurses and surgical technologists to identify practices that created variability and then addressed each one to create a new count policy and reduce the risk of retained surgical items.