NATN endorsement and accreditation. A nurse's perspective

In May 2002, NATN launched a new service known as the Endorsement and Accreditation Service. This article explains the differences between the two parts of the service, what the service entails and how it enables purchasers to influence suppliers to achieve higher standards.

Perioperative nursing and acute pain management

This article explores the broader aspects and opportunities available to perioperative nurses in the field of pain management. It will help to develop nurses' insight into how perioperative nurses can develop their role in pain management. In turn this will benefit patients' service provision and enhance nurses' career pathways.

Comparing patient and nurse perceptions of perioperative care quality

This study compared surgical patients' (n = 874) and perioperative nurses' (n = 143) perceptions of the quality of perioperative nursing care. The data were collected with a structured questionnaire in five hospital operating departments in Finland. The questionnaire items were divided into five main categories (staff characteristics, nursing activities, preconditions, progress of nursing process and environment); some of these categories were further divided into subcategories. Overall, patients tended to give significantly higher (P <.001) ratings than nurses, but for some items the patients had more critical perceptions. The results provide important clues for improving the quality of patient care so that staff activities better serve the needs of patients.

Hospitalized children's descriptions of their experiences with postsurgical pain relieving methods

The purpose of this study was to describe children's (aged 8-12 yr) experiences with postsurgical pain relieving methods, and their suggestions to nurses and parents concerning the implementation of pain relief measures in the hospital. The data were collected by interviewing children (N = 52) who were inpatients on a pediatric surgical ward in the university hospital of Finland. Content analysis was used to analyze the data. The children rated the intensity of pain on a visual analogue scale. The results indicated that all of the children used at least one self-initiated pain relieving method (e.g. distraction, resting/sleeping), in addition to receiving assistance in pain relief from nurses (e.g. giving pain killers, helping with daily activities) and parents (e.g. distraction, presence). The children also provided suggestions, especially as it relates to nurses (e.g. creating a more comfortable environment), regarding the implementation of effective surgical pain relief. However, some cognitive-behavioral and physical methods were identified that should be implemented more frequently in clinical practice. Furthermore, most children reported their worst pain to be severe or moderate, which indicates that pain management in hospitalized children should be more aggressive.

How to use medical devices safely

Perioperative nurses play an important role in the prevention of medical device problems. Be proactive and prevent the harm device problems can cause. Nurses can have a profound effect on eliminating this type of patient harm in the perioperative setting, and through reporting, they can prevent reoccurrence and harm to other patients.

Hemolytic transfusion reaction: safeguards for practice

Most hemolytic transfusion reactions result from administration of ABO-incompatible blood. Even a small amount of incompatible blood may initiate a reaction and cause devastating consequences leading to death. Careful monitoring of the anesthetized patient is important in recognizing symptoms of a transfusion reaction so that the reaction may be promptly detected and treatment quickly initiated. Many factors contribute to blood transfusion errors resulting from the misidentification of either the patient or the blood product. Nursing has opportunities to establish policies and procedures, design nursing practices, and educate staff to help avoid blood transfusion errors.

Increased efficiency through OR redesign and process simplification

Short turnover times and efficient use of time and personnel are hallmarks of an efficiently run OR. When delays occur, time can be lost and the workday prolonged considerably. This article describes changes made in neurosurgical services at Utah Valley Regional Medical Center, Provo. These changes involved redesign of the neurosurgical suite and simplification of processes, which led to a 33% to 55% decrease in turnover times and an increase in team efficiency and the number of nurses proficient in the specialty.

Perioperative care is failing patients in need of surgery

A report by the National Confidential Enquiry into Perioperative Deaths (National CEPOD) has brought perioperative care to the forefront of the healthcare agenda.

Ensuring correct site surgery

In 2000, a report was published that focused on the high rate of medical errors in the United States. Wrong site surgery is defined as any surgery performed on the wrong site or patient or performing the wrong procedure. Since January 1995, 197 wrong site surgeries have been reported through the Joint Commission on Accreditation of Healthcare Organizations sentinel event reporting system. Incidents of wrong site surgery should not happen. The perioperative health care team composed of nurses, physicians, anesthesia care providers, unlicensed assistive personnel, admission workers, clerks, and other ancillary staff members must make patient safety an uncompromising goal. This article describes the problem and identifies potential causes for incidences of wrong site surgery. The article also describes steps to act on AORNs patient safety initiative, which includes five suggestions for the development of any surgical site verification policy. Using these suggestions as guidelines for developing a policy and procedure will help decrease the risk of avoidable errors.

Refusing analgesics: using continuous improvement to improve pain management on a surgical ward

Despite advances in pain control many patients experience moderate to severe pain whilst in hospital. Contributory factors include inadequate assessment and documentation of pain, as well as patient and professional misconceptions. A 28-bedded surgical ward in a District General Hospital in the South of England was the setting for the project. A small preliminary audit of pain on this ward indicated that some patients experienced postoperative pain, which was not effectively controlled. A 'continuous improvement' framework was used to increase understanding of the problem and identify an aim for the project, which was to reduce the number of patients refusing analgesics when offered by nurses. An audit to ascertain how many patients refused analgesia revealed that, of 133 patients offered, 93 (70%) refused. Using the 'Model for Improvement' (Langley et al., 1996) a number of changes were introduced, including a patient information sheet, regular documented pain assessment and an innovative staff education programme. To evaluate if the changes in practice had been successful, further audit data were collected from 167 patients. Sixty-three (44%) accepted analgesics, indicating a significant decrease in the number refusing (P = 0.005). This small project demonstrated that continuous improvement methodology can improve the management of pain and quality of care for patients. Such an approach brings practitioner and patient into meaningful understanding and offers solutions which are realistic, achievable and sustainable over time. Despite finite resources and increased pressure on staff it is possible to motivate people when they feel they have ownership and change is meaningful. Continuous improvement methods offer an exciting, feasible, patient-centred approach to improving care.

Nursing documentation of postoperative pain management

Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation. The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines. The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden. The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines. The result showed that pain assessment was based mainly on patients' self-report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines. The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware.

Benchmarking in ambulatory surgery

The health care industry is relatively new to benchmarking. More clinical benchmarking is needed because little is known about which practices and processes lead to which outcomes. Benchmarking is a valuable quality improvement tool that can be used to improve practices and performances when instituted properly. This article describes the benchmarking process, its usefulness, and how ambulatory surgery centers can improve performance by using benchmarking.

Ethics in perioperative practice--advancing the profession

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and should be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this seventh of a nine-part series that is designed to help perioperative nurses relate the ANA code to their own area of practice, the author looks at the seventh statement, which emphasizes commitment to the profession.

Ethics in perioperative practice--duty to self

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this fifth of a nine-part series that will help perioperative nurses relate the ANA code to their own area of practice, the author looks at the fifth statement, which emphasizes commitment to one's self.