The Air Force Nurse Transition Program (NTP) prepares new graduates for their role as a military nurse through an 11-week didactic and clinical program. The purpose of this study was to examine student performance outcomes for a 15 year old program utilizing high-fidelity human patient simulation (HPS). In addition, the study examined the reliability of a new instrument for evaluating student performance during an HPS scenario. The sample consisted of 181 new Air Force nurses who completed the NTP program at 10 global Air Force training sites. Using a multi-site, pre-test/post-test design, NTP students took part in two HPS scenarios reflecting content of the program (anaphylaxis; bomb blast) prior to training, as well as at completion of the program. Evaluation of student performance during these HPS scenarios was conducted by two experienced nurses using the researcher-developed Simulation Evaluation Instrument. Results indicate an increase in performance scores after the program and a Cohenís Overall Kappa for interrater reliability of 0.78 for the performance instrument. This study will add to knowledge of the NTP Program and psychometric properties of a new simulation performance instrument. Results provide perioperative nurses with evidence for use of HPS for clinical training, competency development, and evaluation.
Surgical Site Infection (SSI) is the most common type hospital-acquired infection in the surgical population with nearly 750,000 occurring annually. An individualís risk for dying is 11 times greater with the occurrence of an SSI. Additionally, SSIs increase length of stay by seven to 31 days per event resulting in $1.6 billion in cost for treatment. Hospitals are challenged to evaluate current practices to decreases SSI. The purpose of this project was to identify which intraoperative prepping solution utilized in our health network for adult open abdominal surgical procedures had the lowest incidence of SSI 30-days postoperatively. A retrospective medical record review was conducted of consecutive patients age 18 years and older undergoing elective open abdominal procedures at four acute care, community hospitals within an integrated tertiary health network in the Southeastern US from December 2008 to December 2010. Results: The sample (N=162) was predominately white (67%) female (67%) with a wound class 2 (58%) and a mean age of 49 (± 13.26) years. Procedures using PCMX intraoperative solution (n = 71) resulted in no SSI, while procedures that used other prepping solutions (CHG, povidone-iodine, and iodine-base with alcohol) (n=91) resulted in five SSIs. Chi-square test indicated a significant difference in the incidence of SSI among PCMX intraoperative prep solution when compared to the other solutions in open abdominal surgical procedures (2 = 4.025 (1, 162), p = 0.045). Research on this subject acknowledges an appropriate and effective surgical skin antiseptic plays a vital role in the prevention of devastating postoperative infections. By staying abreast of research and understanding the advantages and disadvantages of available surgical skin antiseptics, perioperative registered nurses are able to make informed recommendations.
The purpose of this study is to define, quantify, and analyze learning outcomes associated with enhanced versus traditional strategies for teaching perioperative nursing. Does an enhanced perioperative teaching strategy make a difference in learning outcomes? A quasi-experimental design, guided by the Perioperative Nursing Data Set (PNDS), included consecutive cohorts (n = 56, each cohort) in an adult nursing course. The primary investigator implemented the enhanced strategy (didactic, clinical lab, and direct supervision for inpatient perioperative clinical rotation). The traditional strategy included didactics with course faculty, no clinical lab, and an inpatient observational day coordinated by the hospital perioperative services educator. Group designation accounted for completing the inpatient rotation before versus after the first exam. The secondary investigator steered the study design, data extraction, and data analyses. Independent variables were strategy and clinical timing. Dependent variables were scores for intraoperative items on Exam 1, the final exam, and the asepsis item from a standardized comprehensive exam; and number of nursing interventions cited in a clinical paper. Results: Means and proportions 100% correct were significantly higher for Exam 1 intraoperative items, but not for the final exam. Students with the enhanced strategy were significantly more likely to correctly respond to the standardized asepsis item. Post hoc power analyses: moderate to strong Cohenís d (for mean differences) and Cohenís w (for proportion differences). Nursing interventions identified in clinical papers were consistent with PNDS criteria. Limitations: Small numbers in some analyses, purposive sampling, and use of existing course exam items and written assignment. Implications: Findings suggest that the enhanced strategy was beneficial for this sample. Data can be extracted from computerized scoring programs, and standardized testing reports to quantify learning outcomes. An enhanced strategy can be utilized in elective nursing courses, and as teaching practica for graduate nursing students. Simulated OR environments can serve as clinical labs.
The study was initiated to create a better learning environment around diathermy in a department pressured by the economic situation, with cutbacks, time pressure, and demands on higher productivity. The study contains a qualitative pilot study with a hermeneutic and ethical approach, and a clinical follow up study. The pilot study showed that both perioperative nurses and surgeons felt that knowledge about diathermy was given a low priority. The participants requested the need for both theoretic and hands-on learning, to insure a higher knowledge and patient safety when using diathermy in the OR. They also pointed out the need for a more structured and planned learning environment. In the clinical follow up study, the nurse who was responsible for diathermy made an effort to improve the learning environment. One initiative was to make the ways to acquire knowledge easier, so that the nurses would have time to read it in a busy workday. Quick guides on how to use the diathermy were placed on the machines. Another initiative was a workshop for the nurses where they used hands-on learning in small groups and in which they shared experiences and new knowledge. Conclusively, the need for developing a standard learning program for all nurses in the department, to secure patient and staff safety when using diathermy, was acknowledged.
The purpose of this presentation is to demonstrate the implementation of a series of preventative measures to reduce pressure ulcer (PU) prevalence in the cardio-thoracic surgical patient population. As a first measure to reduce the rate of PUs, standard OR (OR) bed surfaces were replaced with non-memory fluid pressure redistribution mattresses in the cardio-thoracic OR suites. This proved to be ineffective. The second measure replaced water-filled warming blankets to reduce negativity between the patient and the therapeutic mattress surface with forced-air. Underbody warming blankets did not reduce the rate of PU. The third measure implemented a therapeutic mattress surface for the immediate postoperative phase, the patient intensive care unit (ICU) experience. The research question: Should the ICU experience be considered an extension of the intraoperative phase of the cardio-thoracic surgical intervention in an effort to reduce the rate of PU in the cardio-thoracic surgical patient population? An ongoing retrospective chart review is performed to collect data on cardio-thoracic patients with PUs reported postoperatively. Data collected two months postimplementation of the therapeutic mattress surface for the patient postoperative/ICU experience demonstrated a dramatic reduction in the incidents of PUs. Preliminary findings revealed a 7.1% reduction in the rate of occurrence of PUs in the cardio-thoracic surgical patient population when compared to the same time period in 2009. Results of this ongoing study continue to demonstrate a decrease in the rate of PU occurrence in the cardio-thoracic surgical patient population.
The purpose of this study is to determine if preoperative carbohydrate rich drinks (CHO) are associated with improved postoperative outcomes and subjective wellbeing. A more important outcome for hospital administrators is whether preoperative loading reduces hospital length of stay, but this remains uncertain. The primary aims of this study were to establish the efficacy of a preoperative carbohydrate drink in shortening time to discharge and to test the feasibility of conducting a larger trial among a more diverse cohort. A prospective, single-site, parallel-group, randomized controlled trial design was used to test the hypothesis that a preoperative carbohydrate drink will result in significantly shorter time to readiness for discharge compared to usual care. Patients undergoing elective bowel surgery were recruited, consented, and enrolled at preadmission clinic and randomized into either the usual care group (control) or the preoperative CHO group (intervention). The primary endpoint was time to readiness for discharge. To show such a difference of reduction of 2.5 mean bed days with 90% power (p
Quality patient care and safety is an ongoing process improvement initiative. Literature and regulating agencies stress the need for improved communication between caregivers. An area for improved communication was needed between the Operating Room Ear Nose and Throat specialty nurse, and the receiving Pediatric Intensive Care Unit (PICU) nurses. Childrenís has 2 OR suites dedicated to the ENT service daily. We transfer approximately 15- 20 ENT patients to the PICU monthly. The process of handoff involved a completion of a paper reviewing lines and tubes, a telephone report to the PICU RN by the OR ENT specialty nurse and the anesthesia team transferring the patient to the PICU. A survey prior to the trial of the form pointed out a lack of pertinent information regarding the OR case. As a Fellow in our Evidence Based Practice Fellowship, the clinical question was addressed ìIs there is a tool or technology to help improve communication between OR staff and the receiving PICU unit staff?î. A review of the literature found the SBAR (Situation, Background, Assessment and Recommendation) format of communication was the best practice fora nurse hand off. A project team developed the OR SBAR form. We have used it for one year with multiple revisions. The form has improved the organization of hand off communication between the OR and PICU. We now use the form as a standard communication for any transfer of patients to any of our Intensive Care Units. The handoff tool has now initiated a tool for the communication between the Peri-operative areas of SDS-OR-PACU.
Advanced nursing culture is conducive to enhance the sense of responsibility and cohesion. The author has hypothesized that heritage of traditional Chinese culture has complementary effects for constructing the culture of ëpatient safety.í The aim of the study has been to evaluate the nursing staffís perception on operating regulations, as well as protecting patient safety, and to explore innovation achievement by combining heritage of traditional culture and nursing culture. It has also tried to explore an effective pathway for cultivating advanced nursing culture through static regulation and dynamic management system, which can summarize a series of methods for building nursing culture up. Methods: Data being analyzed was from Guangdong Provincial Hospital of TCM. The study methods were both theoretical and practice, combined with qualitative and quantitative analysis. Field investigation of nursing culture construction was done at Guangdong Provincial Hospital of TCM. The statistical evaluation was done by using SPSS 17.0 statistic software to input and analyze the data, which was compared with Agency of Healthcare Research and Quality's 2010 database. Amos-7 was applied to perform confirmatory factor analysis (CFA). The results depict systemic explanation of the theory of nursing culture's origin and developmental stage, mission, and other elements. From the point of nursing culture construction practice at Guangdong Provincial Hospital of TCM, we have found several key issues: improvement of the institutional system, optimization of the management system, set up of quality framework, and strengthening continued education, enhancement of nursing brand, establishment of standardization, focus on traditional and innovative thinking, and practice of skills. Comparing the result of ëhospital survey on patient safetyí with AHRQ 2010 database, the nurseís perception of ëpatient safetyí at Guangdong Provincial Hospital of TCM's is at higher level. Conclusion: To achieve progression of contemporary nursing culture, nursing staff should play the role from understanding the essence of traditional Chinese culture. Based on it, they can apply Western idea and methods of management, deepen the connotation of nursing and humane care, enhance the level of nursing culture, and highlight the value of nursing work. ëPatient safety cultureí should be encouraged, which includes performing incident reporting system, strengthening personnel training, enhancing communication effectiveness, and promoting multidisciplinary cooperation
A surgical glove is an important barrier for preventing surgical site infection (SSI) caused by transmission of body fluid and microorganisms from surgical team. Based on previous studies on glove perforations related to compromised asepsis, AORN recommends double gloving and frequent glove changes during invasive procedures. The purpose of this study was to examine the surgical glove perforation incidences and correlated factors between surgical characteristics and glove perforation. Gloves were collected from 277 surgical cases, performed in one tertiary hospital, located in Seoul, Korea. During a two-month period, two types of gloves were used for data collection. Gloves changed throughout procedures due to identified defect were excluded and at the end of the case, only outer layer of gloves were examined. Data was analyzed by SPSS/Win Ver. 18.0 program.Glove perforation rate in dental (53.6%) and orthopedics (34.8%) services was significantly higher than the others (p=.002). The duration of wearing surgical gloves was statistically significant. The 181 to 240 minute group was significantly higher than the group under 90 minutes, 91-180 minutes and over 240 minutes (p=.049). Other surgical characteristics related to the perforation rate were staff role (p=.001), experience (p=.021), and surgery type (p=.001). Regardless of improvement of surgical gloves and recommended practice, the unrecognized glove perforation rate was still high (28%). Based on this experimental research, it is suggested that surgical team should not only wear double gloves but also periodically exchange gloves especially between three and four hour periods with consideration of other surgical characteristics.
Austin Area AORN chapter is experiencing the same issues as many other chapters; membership decreasing and fewer active members. The 2011-2012 Officers and Board members have noticed the lack of participation and support of the chapter from senior surgical services management teams. In an effort to assess what barriers the managers might have preventing them from participating in the local chapter, an eight question survey was developed. Operating Room managers had access to the survey through an on-line survey tool, attached to e-mails, and by personal response. An action plan was developed based on the results of the survey to involve the senior facility leaders to include a panel discussion from the area managers as a continuing education presentation. Austin Area AORN would like to share this tool at assist other chapters in dealing with membership problems.
Raising Awareness of Wounded Warrior Project (WWP), Soldier Ride: Tampa, Florida The WWP: To honor and empower wounded warriors. PURPOSE ïTo raise awareness and enlist the publicís aid for the needs of injured service members. ïTo help injured service members aid and assist each other. ïTo provide unique, direct programs and services to meet the needs of injured service members. WWP helps warriors achieve independence and pursue an excellent quality of life. Soldier Ride is a WWP initiative that provides adaptive cycling opportunities across the country to help wounded warriors restore their physical and emotional well-being. WWP provides equipment and support to participating injured service members at no cost to the warrior. If Chapter Members, Team members, family or friends wanted to support the initiative, there was a nice web link to Soldier Ride for donations. It was a rewarding ride, not a race, because the warriors are the first riders following the lead vehicle. I was able to raise $575 for this great cause. All the Tampa riders raised over $40,000. I highly recommend this initiative! I was able to increase awareness for WWP and in a small way pay their courage forward.
This evidence-based study answers the clinical question: Can a programmatic approach to environmental hygiene improve the thoroughness of cleaning in the OR? Environmental hygiene is an important but sometimes overlooked component of safe patient care in the OR. Evaluations of OR cleanliness are usually based on subjective visual observation. A study was conducted at four hospitals with a combined total of 72 ORs to determine whether focused training on best practice processes, products, and tools for effective OR cleaning and disinfection, the use of an objective environmental monitoring tool, and staff performance feedback would improve the thoroughness of disinfection cleaning (TDC). Pre- and post-intervention assessments of TDC were conducted for end of case and terminal cleaning in the OR. TDC was evaluated with a transparent, fluorescent marker and handheld ultraviolet (UV) light used to determine if high touch objects had been contacted by a wet disinfection cleaning cloth, as demonstrated by complete removal of the fluorescent mark. In the pre-intervention period, baseline TDC was evaluated. During the intervention period, staff were trained on high touch objects and best practices for EH and provided with processes and tools to improve TDC. In the post-intervention period, TDC was again evaluated. Preliminary results indicate that end of case TDC in the pre-intervention period averaged 23% while post-intervention end of case TDC averaged 64% for a 41% overall improvement. Terminal Cleaning TDC in the pre-intervention period averaged 40%, while Terminal Cleaning TDC in the post-intervention period averaged 55% for a 15% overall improvement. These results were obtained after one cycle of training, monitoring, evaluation, and staff feedback. A programmatic approach to environmental hygiene training, processes, tools, environmental monitoring, and performance feedback can improve end of case and terminal cleaning in the OR.
Corneal abrasion is a painful scrape on the superficial layer of the eye. It is the single most common type of postoperative ocular injury especially with general anesthesia (83%), accounting for 3% to 8% of anesthesia-related malpractice claims. The time it takes for the ophthalmologist to diagnose and initiate treatment is between 2 to 3 hours. After several occurrences, the ophthalmologist decided it is the responsibility of the anesthesia department to treat this condition. Problems and confusion arose when different methods were employed by the anesthesia team to treat the injury. The goal in developing an EBP guideline in management of corneal abrasions is to become familiar with the symptoms of the condition, standardizing the treatment process to prevent further complication. The methods utilized in meeting the goals of this project are: conducting literature review, creating EBP guidelines, auditing of time interval of treatment before and after implementation of guidelines, and evaluating staff satisfaction. Prior to implementing the guidelines, 90% of the patients had their corneal abrasion managed within 2 to 4 hours. After establishing the guidelines, 86% of the patients were managed within 15 to 30 minutes. One hundred percent of the nurses surveyed were satisfied with the guidelines for its consistency. Establishing an EBP guideline facilitates prompt treatment of corneal abrasions, promoting patient safety, and preventing further complications.
Surgical facilities have traditionally allowed hospital laundered, disposable and home laundered cover jackets and hats. A team of both new and experienced OR nurses in collaboration with our EBP consultant and librarian assessed the literature, professional standards and community practice to determine if there was sufficient evidence to support a practice change requiring use of only disposable or hospital laundered apparel to lower bacterial contamination and infection rates. Our team was charged with evaluating the evidence to determine if a practice change was necessary to support this new practice. Review of twenty-six articles revealed strong evidence to support the use of hospital laundered or disposable jackets and scrub hats. A survey of twenty-one area hospitals revealed that the majority did not allow home laundered hats and jackets (57% and 71% respectively). Based on consistent and clear evidence our team recommended a practice change to eliminate use of home laundered attire and revised a current policy that will be submitted to our nursing divisionís Practice Council and Leadership Committee for approval. Education of both nursing and medical staff will include a presentation of the evidence to support this change and will be coordinated through our unit-based shared governance team. Coordinate education efforts with Practice Council and Center for Clinical Excellence will be implemented. Development of flyers highlighting key practice changes will be posted on nursing units This revised policy will augment infection prevention practices within our OR and assure best practices to minimize intraoperative infections and the transmission of bacterial contamination.
Background: The PACU is an environment where patients wakeup slowly after receiving anesthesia. A quiet non-stimulating atmosphere is the preferred setting for these patients. Instead, patients often wake up to alarms, loud conversations, noisy equipment, and ringing phones. Studies show that high levels of noise have negative physical and psychological effects on patients, including: sleep disruption, increased stress, and decreased patient confidence in the competence of their caregivers (Miller, 2006). The Joint Commission cites noise as a potential factor related to medical and nursing errors, stating that ambient sound environments should not exceed the level that would prohibit clinicians from clearly understanding each other (TJC, 2004). Purpose: The purpose of this quality improvement project is to determine whether implementation of noise reduction strategies and staff education will decrease sound levels in the PACU and result in improved patient and nurse satisfaction. Methods: Noise Reduction Strategies ï Yacker Tracker-noise monitoring device ï Noise canceling devices- MP3 players, IPADís, ear plugs ï Signage-HUSH posters inside and outside the unit ï Staff awareness and education of noise levels and the negative effects of noise ï Zoning- patient care and nursing areas Results and Outcomes: Pre-implementation environmental sound levels were consistently higher than recommended levels, as determined by Environmental Protection Agency guidelines for hospital noise levels in patient care areas. Both inpatients and outpatients were surveyed over a 4 week period; 124 patients completed the noise survey. PACU nurses were also surveyed, and 30 out of 33 nursing surveys were returned. Patients overwhelmingly reported that a quiet environment is important to them, while the majority of nurses (67%) stated that noise levels affected their delivery of care. The majority of patients surveyed (65%) stated they would have used a noise canceling device had it been offered to them, and most nurses (93%) indicated they would offer these devices, if available, to help alleviate noise levels. Post intervention survey results showed significant reduction in noise as perceived by the patients. Patients were receptive in using noise canceling devices as offered to them by staff members. Nursing satisfaction scores showed increase awareness of noise in the PACU environment. Implications for Practice: Various strategies can be utilized to reduce noise levels in the PACU. Education and visual cues are effective in increasing staff awareness of noise levels. Reduction of noise levels decreases anxiety for patients recovering from their surgical experience, and promotes staff satisfaction due to less distraction.
The purpose of this evidence-based practice project was to identify perioperative practices that can reduce occurrence of perioperative pressure ulcers (PPUs). At Huntington Hospital, the rate of PPUs was comparable to the national average. The desired outcome was reduction of PPUs. A perioperative pressure ulcer prevention (PPUP), team was formed, including preoperative, OR, post anesthesia care unit, and wound ostomy continence nurses. Evidence-based practices were identified from peer-reviewed journal articles and AORN Standards and Recommended Practices. Literature described intrinsic and extrinsic factors that contribute to PPU occurrence and methods to reduce extrinsic risks. The PPUP Team recommended using Braden Risk Assessment Scale for identification of high-risk intrinsic factors of all surgical patients. Inservices began immediately for each department, including preoperative skin assessments, control of extrinsic factors through use of pressure redistribution, positioning, moisture management in the OR, and patient-turning schedules in PACU. A tool was developed to improve PPUP communication and track PPUP techniques. Resulting changes in practice have lead to decreased incidence of PPUs, as measured by our Nursing Quality Council. The PPUP team approach is a successful method to achieve desired outcome of PPU reduction. Perioperative nurses who share the goal of PPU reduction can benefit by starting a team like ours. Resulting changes in practice have lead to decreased incidence of PPUs, as measured by our Nursing Quality Council. The PPUP team approach is a successful method to achieve desired outcome of PPU reduction. Perioperative nurses who share the goal of PPU reduction can benefit by starting a team like ours.
Purposes: Surgical Site Infections (SSIs) create a gamut of implications to the health care facilities, providers, delivery models, and costs besides the impact that affects the patient and their significant others. The causes of SSIs are complex and multiple but the majority is known to arise from the surgical patientís own native bacteria. Preoperative vaginal preparation (PVP) is a preventive intervention to SSIs in surgeries involving the female reproductive system. Further scrutiny of guidelines, current practices and research studies is crucial in deducing implications to practices based on these evidences. The purposes of this literature review are 1) to examine current PVP guidelines set by: Association of Operating Room Nurses (AORN), Center for Diseases Control and Prevention (CDC), Joint Commission on Accreditation of Hospital Organizations (JCAHO), Food and Drug Administration (FDA), and Manufacturers; 2) to scrutinize research studies on PVP and synthesize the data; and 3) to draw practice implications from the review. Search Strategy: Electronic search was utilized to locate guidelines and research studies on PVP. Websites of organizations are the sources of the guidelines. MEDLINE search on PVP studies was used. References on the research studies were located as well to get pertinent literature. Results and Synthesis of Evidence: 1. Guidelines emphasized using approved antiseptics and in accordance to manufacturerís instructions. Manufacturer states 4% Chlorhexidine Gluconate (CHG) should not be used in the genitalia, 7.5% Povidone Iodine (PI) scrub is for external use only, 10% PI solution is indicated as a PVP agent by some manufacturers but others label it for external use only. 2. Manufacturer guidelines are not followed in practice settings as well as in research studies. That is, off label usage of agents as PVP is noted. However, the agents have potential to decrease infection morbidities but non usage of such does not differ significantly. Besides, the agents when used in PVP were also implicated for negative patient outcomes. Baby shampoo with normal saline is a potential PVP agent but this warrants further investigation. Practice Implications: 1.1) Usage of PVP agents should be based on AORN, CDC, JCAHO, FDA, manufacturerís guidelines and current evidence. 1.2) Decision in the off label usage of PVP agents requires multidisciplinary consideration and the affirmative decision to do so places the health care facility in assuming liability. 2.1) CHG and 10% PI solution have potential to decrease infection morbidities, however, the results do not differ significantly with non usage of PVP. 2.2) Patient characteristics, safety and clinical outcomes are of utmost consideration in the usage of PVP agents. 2.3) Further research on potential PVP agents should be done to establish wider product selection that results to positive patient outcomes. References: Please refer to poster Disclosure: There is non-FDA use of medical devices or pharmaceutical products included in this poster.
What changes need to occur in procedural areas to become compliant with Joint Commission standards on smoke evacuation? Smoke produced from ablated human tissue is equivalent to smoking cigarettes and contains the same chemicals. It produces an offensive odor, and can cause ocular and upper respiratory irritation. Observational data was obtained from the OR and other procedural areas which produce smoke. Data included effectiveness and noise level of smoke evacuators. Evacuation products were evaluated for applicability for all procedural areas. Current practice for evacuation of smoke included a combination of a centralized smoke evacuation system, free standing units, and standard vacuum. Surgery clinics were using smoke evacuators for laser plume, but not for smoke generated from ESU units, and contained no centralized suction. Barriers identified from assessment: multiple smoke evacuation products and evacuators; increase in number of product and cost; compliance issues; multiple products, venders, and technology; and many levels of smoke evacuation. Products and practice were standardized between procedural areas based on evaluation and needs assessment. Education was developed and delivered on new policy. Gaps were identified and a plan put in place to provide the resources necessary for regulatory compliance. Instituting a new policy based on regulations can only be successful if a planning model is put into place. Identifying stakeholders, resources, and barriers, and basing practice change on evidence is imperative for a successful process improvement.
OR (O.R.) efficiencies affect the bottom line, patient, physician, and employee satisfaction, and the ability to work in emergent cases in a timely manner. at University Hospital St. Paul, University of Texas Southwestern Medical Center, when we started our review of turn-around time we decided to include all of the staff that we could involve. A survey was posted both electronically and provided in paper form to give as many staff members as possible the ability to include their feedback on this very complicated process. Survey return was approximately 40% of the O.R. staff which provided a broad base of information and ideas associated with turn-around time. In parallel we looked at services that had rapid turn-around to determine what was occurring to facilitate the process, such as team members, complexity of the procedure, instruments, supplies, and equipment required. Survey data was compiled and best practices identified within the O.R. resulting in a blended implementation of best internal practices and process changes. The team involved in this project included O.R. staff and leadership, anesthesia providers, and surgeons, which reported back to an O.R. leadership team that includes leadership from the three (3) O.R. sites on campus.
Maintaining Nursing Excellence in the OR: Bone Flap Storage Kit for Compliance Autologous cranial bone flaps are recovered and stored to relieve brain swelling after traumatic brain injury. These flaps are stored for later re-implantation after the brain swelling has subsided. It is very important to follow American Association of Tissue Bankingís (AATB) recommendations as well as recommended practices for tissue storage by AORN while storing the flaps for later re-implantation. According to AORN and Joint Commission, hospitals storing autologous skull bone flaps must adhere to the Joint Commissionís Tissue Storage standards. A custom autologous skull bone flap bone flap storage kit has been developed at this authorís facility that has all the supplies and instructions for the nurse to follow on recovery, wrapping, labeling, storage & preparation of autologous bone skull flaps for later re-implantation. This kit meets all the required standards and is a staff satisfier as they do not have to search for the policies and the protocols in the middle of night on how to handle the autologous skull flap while helping the surgeon with traumatic brain surgery. Storing autologous cranial skull flap in the OR should be taken seriously. Having complete bone flap storage package increases staff awareness, surgeon and patient satisfaction and increases compliance of the hospital for storage of the autologous skull flap.