CORE Award Application
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AORN CORE Award Application Template 2
Introduction
Congratulations on choosing to apply for the CORE Award! Like many other perioperative services departments, you are on a journey to distinguish yourselves by improving every facet of patient care. This application template, along with the CORE Award Program Handbook and other resources available at www.aorn.org/core, will support you in completing the CORE Award application process.
Instructions for Use
Before using this template, it is recommended that you read and familiarize yourselves with the CORE Award Handbook. It contains detailed information about the CORE Award and application process. Whether you are applying for designation or redesignation the application and submission process is the same.
After you are prepared to write your application, you will use this form to write your CORE Award Application. Please be sure to follow these instructions:
For your application submission, you will need to download and save this CORE Award Application Template. You will enter your responses in the appropriate “Response” box under each criteria question. After you have completed it, you will upload your saved document during the online submission process.
Pay special attention to font size and length restrictions:
o The minimum font for the application is 10. The template is formatted for this font size.
o Including the pages of the application template, the maximum length is 50 pages. If the application exceeds 50 pages, only the first 50 pages will be reviewed.
Ensure all graphics, particularly in the Outcome Measurement section, are appropriately labeled.
Avoid using acronyms and abbreviations. They can have more than one meaning, which detracts from an application's clarity. If it is essential to use an abbreviation or acronym, it must be spelled out the first time it is used.
Do not include patient- or employee-specific information. If confidential information is included in the application, all identifying details must be removed.
When your application has been written and proofread, you are ready to begin the online submission process. Click “Application Process” on the CORE Award home page (www.aorn.org/core). Then click “Online Submission Process,” and log in with your member or customer ID number. The person who logs in and submits the application will become the primary contact associated with the application.
After you log in, you will be guided through a series of steps to submit your application and payment. If you have additional questions about the CORE Award or the Application Template, please contact us at [email protected]. 3
Unit Profile
The Unit Profile describes the framework within which your perioperative services functions. The Unit Profile should identify the key characteristics of your perioperative services, including the environment of care and relationships with other departments, patients, families, and stakeholders. Information from the Unit Profile helps reviewers better understand the composition and structure of your perioperative services and facility. You do not need to include detailed information about your processes or outcomes in the Unit Profile. You will have an opportunity to provide that information when answering the criteria questions in categories 1-6. The Unit Profile is not scored.
Criteria Questions 1 Describe the facility designation in which perioperative services functions. Notes: The facility designation describes the overall structure within which perioperative services functions (eg, teaching, nonteaching, trauma designation, rural, urban, critical access, government) The focus is on the inpatient perioperative services.
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2 If part of a multi-organizational system, describe the structure of the system, including the number of facilities.
Notes: A multi-organizational system describes the organizational structure of multiple facilities in one organization creating a complex health system. Each site must qualify individually for the award. Response
3 What surgical services are excluded within the facility (eg, transplants)? Notes: The scope of surgical service is the surgical classification of the scheduled procedures as defined by the surgeon’s area of expertise or health care organization’s medical by-laws.
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4 How does perioperative services contribute to the mission, values and vision of its hospital/system? Notes: Each unit in the hospital contributes to the hospital’s overall mission and vision. Articulate perioperative services role in achieving that mission, value, and vision. Response
5 What are the major cultural populations cared for by perioperative services? How does perioperative services meet the cultural/spiritual needs of the patient and family for each major group? Notes: Describe the demographics of the patient population including major diagnoses and procedures, age and cultural or ethnic groups. Response
6 How many ORs are there in the surgical suites (by site if appropriate)? Notes: Describe the number of rooms within perioperative services in which operative or other invasive procedures are performed. Include any specialty rooms (eg, cystoscopy rooms, endovascular suites).
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7 How many cases are performed per year? Notes: Describe the number of individual patients having surgery or a procedure performed each year. Multiple procedures performed on one patient at the same time are counted as one case.
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8 Describe the multi-professional staff members that provide hands-on patient care within perioperative 4
services. Include the number and type of nurses, surgical technicians, RN first assistants, ancillary assistants/transport, advanced practice nurses in the OR, physicians, anesthesia providers, pharmacists, and so on. Include education levels, skill mix, and bargaining units. (See leadership section for managers, leaders in the Handbook). Notes: Skill mix describes how many of each type of care provider is generally available for each patient care shift. Identify the titles and roles of each type of provider (eg, unlicensed assistive personnel, RN). If staff includes unionized workers, identify the union and its effect on the nursing structure.
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9 How many perioperative services staff members are members of AORN?
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10 Describe other key stakeholders who collaborate with the perioperative services team to provide services/consultation to the patient. Notes: Other key stakeholders could include social workers and representatives from the pathology, laboratory, radiology, biomedical engineering, purchasing, or respiratory therapy departments, as well as others. Response
11 Describe the perioperative services structure (eg, councils, leadership team, shared governance). How do leadership relationships and accountabilities for perioperative operations function between surgeons and the anesthesia, nursing, administration, and central processing teams? Notes: Describe how physicians, nursing administrators, and central processing department members think and feel about perioperative services. Example of key factors include physician, nursing administration, and central processing involvement; communication from administration; quality of nursing care; medical staff governance; and other specific organizational issues. The governance structure should describe how decision-affecting operations are made within perioperative services. Two examples are top-down leadership and unit-based councils. Response
12 Describe the key challenges for perioperative services. How are these challenges addressed to ensure optimal patient care? Notes: Challenges might related to technology, people, or other resources or regulatory requirements. Response
13 How does perioperative services access organizational resources? How does it remove organizational barriers? Notes: Organizational resources should include resources needed to provide optimal patient care. They could include personnel, equipment, or financial support. Organizational barriers should include system- related processes and policies that affect efficient and timely delivery of patient care and affect patient care outcomes. Barriers may include inadequate personnel, barriers within the physical environment, ineffective decision-making structures or lack of equipment. Response
Category 1: Leadership Structures and Systems—150 Points 5
Perioperative leaders are integral to ensuring a healthy work environment that focuses on the delivery of the best care for patients and families. In perioperative services, the best care may be reflected in a commitment to systematically develop and train nurse leaders; ensure accountability; advocate and participate in decision making; and provide meaningful recognition to staff. Creating a sustainable healthy work environment can improve the care delivery environment, thereby improving clinical outcomes, patient and family satisfaction, and staff member satisfaction and retention.
The criteria questions in this category are aimed at soliciting information about how your perioperative leaders support and maintain a healthy work environment. For each question, reviewers will evaluate the comprehensiveness of your approach; application and integration across staff and key stakeholders; and evidence of continued evaluation, shared learning, and process improvement.
Criteria Questions 1 Who are the perioperative leaders in your facility and describe the structure. How are the perioperative leaders educationally prepared, trained and supported to meet the responsibilities of their jobs? How are they held accountable by the team including surgeons and anesthesia providers? Notes: A perioperative leader is anyone who has daily responsibility for departmental function and may include managers, supervisors, charge nurses, educators or directors. They may be held accountable through formal processes such as peer review, performance evaluation, and/or performance against measurements and goals. They may also be held accountable through formal or informal feedback mechanisms or surveys. Attach organization chart.
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2 How do the perioperative leaders guarantee joint accountability between medical, nursing and other key leaders?
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3 How do the perioperative leaders interact with staff through a shared governance model to build relationships, provide timely feedback and ensure patient-centered care? How do they encourage/ensure frank, two-way communication throughout perioperative services? How do they communicate key hospital decisions and information to staff? Notes: Include frequency of interactions and models of communication, both formal and informal. Also include accountability structures and daily supervision. One example would be a Perioperative Executive Committee which would include all key nursing and medical staff stakeholder representatives. Response
4 How do the perioperative leaders hold staff members accountable for practicing within their individual scope of practice? How do they evaluate staff member professional practice and promote evidence based and professional development? Notes: Scope of practice defines the boundaries/limits of practice for individual care providers (ie, the ability to do a particular activity based on education, license or training). Professional practice is defined by the standards of practice and standards of care set by the profession and provides a framework for evaluating how a particular group meets the expected outcomes.
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5 Describe the structure of the professional development program and how it is evaluated. Notes: The professional development program evaluation may include use of surveys, evidence of staff mentorship and subsequent promotions, and others. Reward programs may include opportunities for advancement, salary considerations for certification programs, career ladders, and succession planning.
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6 How is professional development recognized? What active role does the perioperative leaders take in recognizing professional development? Notes: Professional staff members can be recognized through understanding what the staff members believe is important to them, which may include a self-governance model with the ability to have direct input into schedules, time off, and career ladders. Other considerations for recognition include membership and active engagement in professional associations, participation in academic programs to enhance knowledge, and certification programs.
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7 How is the culture of safety evaluated? How is this information used to make improvements to the culture of safety within perioperative services? Notes: Culture of safety can be evaluated through the use of a tool such as a valid culture of safety attitude questionnaire (eg, AHRQ).
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8 How do the perioperative leaders empower the nursing staff to participate in evaluation/selection of equipment/supplies? Notes: Demonstrate evidence the institution is providing nurse sensitive value based purchasing through balancing costs with quality in the decision making process. Demonstrate evidence of efforts towards standardization to support quality outcomes through reduction in variability.
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9 How is physician satisfaction monitored within perioperative services? What are the key factors that affect physician satisfaction? How are they physician satisfaction scores communicated and how are the scores used to make improvements within perioperative services? Notes: Describe how physicians think and feel about perioperative services. Example of key factors include physician involvement in decision making and purchasing of technology, communication from administration, quality of nursing care, medical staff governance and other specific organizational issues.
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10 How is patient/family satisfaction monitored within perioperative services? What are the key factors that affect patient/family satisfaction? How are the patient/family satisfaction scores communicated and how are the scores used to make improvements within perioperative services?
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11 Describe the programs or actions implemented to address patient safety risk areas. Notes: Responses may include performance improvement programs and patient safety programs (eg, falls, use of pneumatic tourniquets, workforce fatigue, aspiration).
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Category 2: Appropriate Staffing and Staff Engagement—100 Points 7
Appropriate staffing is key to ensuring the provision of safe, quality, patient-centered care; it also ensures the safety, satisfaction and retention of competent staff. Although staffing can be complex, ensuring an effective staffing plan can positively affect the measurable outcomes on the unit.
The criteria questions in this category are aimed at soliciting information about how perioperative services engages, manages and develops staff. For each question, reviewers will evaluate the comprehensiveness of your approach; application and integration across staff and key stakeholders; and evidence of continued evaluation, shared learning and process improvement.
Criteria Questions 1 Describe the levels of education and certification held by each perioperative services staff member by percentages (eg, AD, BSN, MSN, CNOR, CST). Notes: The IOM report on nursing education recommendations include: “Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.” “Increase the proportion of nurses with baccalaureate degree to 80% and double the number of nurses with a doctorate by 2020.”
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2 How are staffing needs determined for perioperative services including required skills, competencies, staffing levels and skill mix (RN vs ST)? How does your perioperative services account for seasonal variances? What key measures does perioperative services use to evaluate the effectiveness of staffing decisions? How do these measures assess staffing and adjust to changing staffing needs after a plan is established? What creative ways do you use to staff based on patient acuity in the OR? Notes: Describe the staffing plan for your patient population including skill mix and the use of equipment specialists, biomedical technicians, NP, CRNFA, CCS, and similar staff members assigned to perioperative services. You may use skill mix in perioperative units per National Database for Nursing Quality Indicators (NDNQI) to describe skill mix.
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3 Describe how you use advance practice RNs.
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4 Do you have specialty teams? If yes, how is staffing determined between specialty teams? Between skill mixes? Response
5 How is the staff mix in perioperative services managed to ensure an effective match between patient needs and nurse competencies? How is the role and related skill competencies of the care team aligned with the specific clinical, spiritual and cultural needs of patients? Notes: Describe what processes are in place to ensure an effective match between patient needs and nurse competencies, including formal and informal acuity-based systems, technical equipment needs, creative staffing plans, call-converted to work, overtime, hospital time off. Response
6 How does perioperative services recruit, hire, place and retain new staff? How do staff nurses and other key stakeholders participate in staffing decisions, including planning, hiring, orientation, education, and evaluation? Notes: Examples of staff participation in staffing decisions might include peer reviews, preceptor or mentor programs, group interviews or nurse shadowing.
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7 How does perioperative services maintain a safe, secure and supportive work environment? What are the key measures and results for staff safety? Notes: Measurements of staff safety might include employee health services reports, employee incident reports and the subsequent education, teaching, and corrective action plans involved to make perioperative services area a safer place to work.
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8 What formal and/or informal methods are used to determine staff satisfaction? What are the measures and results for staff satisfaction within perioperative services? How do perioperative services results compare with perioperative services goals and other appropriate comparisons? Notes: Methods to determine staff satisfaction could include formal surveys, absenteeism rates, turnover, list of applicants waiting to transfer to the unit, or informal feedback. Describe the level of satisfaction that employees within perioperative services have that indicates their level of engagement within the work environment. Comparisons might include other units, overall facility, regulatory requirements, external benchmarks, employee satisfaction committee and the unit’s mission.
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9 What are the key factors that affect staff satisfaction? How are the staff satisfaction scores communicated and how are the scores used to make improvements within perioperative services? Notes: Examples of key factors include treating employees with respect, employee recognition, empowering employees, benefits and compensation, and positive leadership. Attach the most recent employee survey scores for perioperative services in the Outcome Measurement section.
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Category 3: Effective Communication—50 Points
Skilled communication is an important component of a healthy work environment and supports true collaboration to provide quality patient-centered care.
The criteria questions in this category are aimed at soliciting information about how perioperative services ensures effective communication among all staff that provide care. For each question, reviewers will evaluate the comprehensiveness of your approach; application and integration across staff and key stakeholders; and evidence of continued evaluation, shared learning, and process improvement.
Criteria Questions:
1 How do perioperative leaders ensure that all staff members are skilled in effective communication and collaboration? Notes: Methods to ensure members are skilled in effective communication might include formal training or coaching (eg, team training, informed consent training).
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2 How do perioperative leaders ensure that all key stakeholders communicate effectively for optimal patient care? How is transparency demonstrated in perioperative services to report near-misses and critical events without the fear of retaliation? How does perioperative services respond to sentinel event notices from state organizations and regulatory or accreditation bodies? How is this information disseminated to staff? Notes: Examples of stakeholder communication processes to ensure optimal patient care could include interdisciplinary care teams, plans of care, speak up, stop the line, red rules, caregiver handoffs (eg, TEAM 9
STEPPS, SBAR) shift reports, break reports, and team huddles. Sentinel event notices may come from Department of Health, Hospital Associations, The Joint Commission, vendors, the FDA, or other organizations. Response
3 Describe the process for assuring coordination across the continuum of care for the surgical patient. Include processes for scheduling the procedure, preoperative assessment and teaching, medication reconciliation, intraoperative patient care plans, patient education, and postoperative discharge planning. Response
4 How do perioperative leaders put processes in place at all levels to objectively evaluate the results of decisions including delayed decisions and indecisions? How does perioperative services identify and resolve care-related ethical issues? How are traumatic, stressful incidents handled? How is learning shared? Notes: Mechanisms to objectively evaluate results of decisions might include critical incident debriefs, trauma conferences, review of medical or nursing morbidity and mortality conferences, and trauma code analysis. Does perioperative services or the organization have a formal program for debriefing? For stress reduction? Does perioperative services or the organization have the ability to allow the staff to decompress after a traumatic event relieving them of clinical assignments or providing a peer support network?
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5 How do perioperative leaders address and eliminate abusive and disrespectful behaviors? How is staff encouraged to address abusive and disrespectful behaviors? Notes: Examples of processes to ensure that abusive and disrespectful behaviors are addressed and eliminated could include zero tolerance policies or joint nurse/physician elevation and resolution processes.
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Category 4: Knowledge Management, Learning and Development—50 Points
Continued growth and development through education and training in the ever-changing field of healthcare can improve outcomes and satisfaction.
The criteria questions in this category are aimed at soliciting information about how perioperative services ensures staff competency among those who provide care; and manages and encourages knowledge sharing. For each question, reviewers will evaluate the comprehensiveness of your approach; application and integration across staff and key stakeholders; and evidence of continued evaluation, shared learning, and process improvement.
Criteria Questions: 1 How do perioperative leaders ensure that all staff members are oriented and competent to provide safe care to patients? How is the orientation plan tailored to individual needs? How is feedback from orientees incorporated into the orientation/onboarding process?
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2 Describe perioperative services continuous learning and ongoing staff development structure. Within your response, include how learning and development needs are identified and validated by individual staff members, supervisors, and managers. Notes: Sources to identify learning and development needs include, but are not limited to quality indicators, patient satisfaction results, regulatory and accreditation requirements, AORN standards and 10
recommended practices, and other standards.
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3 Describe how learning and development needs translated into action. How do both new knowledge and skills get reinforced on the job? Notes: Tools to translate learning and development needs into action might include perioperative education or individual development plans, including short- and long-term goals.
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4 Provide examples of how staff development has changed practice in perioperative services. Response
5 Describe how competencies are assessed in perioperative services, including critical competencies (eg, high risk/low volume activities such as malignant hyperthermia, OR fires), both for new hires and for annual evaluations. Notes: Address validation of staff members new to perioperative services, contract staff members, and temporarily assigned staff members. Include mentor or formal orientation programs if in place. Examples of annual clinical competency evaluation include competency fairs, competency checklists, Periop Mastery Program, certification, and continuing professional academic education.
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6 Describe how perioperative leaders identify and manage issues that create moral distress for staff. How is learning shared within perioperative services? Notes: Moral distress occurs when a staff member knows the ethically appropriate action to take but cannot act upon it, or when a staff member behaves in a manner contrary to his or her personal and professional values, undermining his or her integrity and authenticity. Identifying and managing issues that create moral distress may include monitoring the clinical climate to identify recurring situations that result in moral distress, protocols for situations that cause moral distress, critical stress debriefings, or grief counseling.
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7 What formal and or informal methods and measures determine satisfaction of interactions, processes and systems between perioperative services and those to or from which you transfer patients?
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8 What form and or informal methods and measures determine satisfaction of interactions, processes and systems between perioperative services and those departments you interact with frequently (eg, central sterile processing, infection prevention, pharmacy, quality, laboratory, pathology, radiology, environmental services)?
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9 Describe how health information technologies are used to improve patient safety (eg, computerized physician order entry, barcode/radio frequency identification sponges and instruments, clinical decision support).
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Category 5: Evidence-Based Practice and Processes—200 Points 11
The ever-changing healthcare environment demands that patient care practices are based upon the most current and relevant information. To do this requires continual assessment, innovation, and improvements. Ensuring evidence-based practices directly relates to positive patient outcomes and satisfaction.
The criteria questions in this category are aimed at soliciting information about how perioperative services engages all staff members to achieve better patient outcomes, improve processes, and stay current with evidence-based practice and research. For each question, reviewers will evaluate the comprehensiveness of your approach; application and integration across staff and key stakeholders; and evidence of continued evaluation, shared learning, and process improvement.
Criteria Questions 1 How do perioperative leaders ensure that policies, procedures, and protocols used in perioperative services are based on nationally recognized evidence, standards and best practices (eg, immediate use steam sterilization per AORN guidelines and the Association for the Advancement of Medication Instrumentation)? Notes: Include sources of evidence used based on the patient population served by perioperative services.
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2 Describe how a culture of inquiry is fostered within perioperative services. Notes: Include perioperative research and nursing accountability for research, such as data collection, primary investigator, or performance improvement activities (eg, Institute for Healthcare Improvement Global Trigger Tool for Measuring Adverse Events, Root Cause Analysis, failure mode and effects analysis). Response
3 How do individuals in perioperative services stay current with the latest advances to support clinical practice? How do they share information with others in perioperative services?
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4 Describe how new knowledge is translated from evidence-based research into practice and how changes in practice are measured. Notes: Include perioperative research and nursing accountability for research such as data collection, primary investigator, or performance improvement activities (eg, IHI Trigger Tool, RCA, FMEA). Describe reporting mechanisms and processes to share learning within perioperative services.
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5 How does perioperative services prevent patient injuries in the following areas: a. Wrong site/procedure/patient surgery b. Retained surgical items c. Medication errors d. Failures in instrument processing e. Prevent pressure injuries f. Specimen management errors g. Surgical fires h. Perioperative hypothermia i. Burns from energy devices j. Difficult intubation or airway emergencies 12
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6 How does perioperative services’ physical environment enhance and support improved patient outcomes. Notes: Responses may include traffic patterns, environmental cleaning programs, waiting area family communications, attire and noise level moderation, (eg, noise limiting curtains). Responses may also include any committed plans to enhance the environment.
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7 How does perioperative services support patient and family engagement and respect the patient’s privacy during the operative or other invasive procedures? Notes: Response might include patient/family satisfaction programs, communication mechanisms, postanesthesia care unit visitation policies, infant/child orientation processes/support, and induction/emergency protocols that support patient care. Consider the patient waiting areas, preoperative and postoperative areas, family lounges, and similar areas.
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8 How does perioperative services support emergency readiness? Notes: Examples might include consistent evaluation of emergency equipment needs (eg, 24/7 emergency carts including craniotomy, caesarean birth, abdominal carts), rooms set up for emergency cases (eg, cardiac cases), and subsequent trauma debriefings to evaluate emergency procedures to determine steps to improve the process of emergency readiness.
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9 How does perioperative services provide consistent pain management with local/regional/IV sedation for specific patient populations? Notes: Responses might include policies and procedures for pain management using local/regional/IV sedation, training to ensure inter-rater reliability for pain management and sedation level verification, and evidence of staff knowledge in the rescue of patients who are inadvertently over sedated.
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10 How does perioperative services incorporate the perspectives of the patients and their families in education and support for decisions that affect the ongoing physical and psychological needs of patient care? Notes: Examples include preoperative and postoperative phone calls, preoperative visits, formal patient/family communication mechanisms, advance directives, patient/family education and transference of communication to anesthesia/surgeon providers.
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11 Describe how the healthcare record uses a standardized language (eg Perioperative Nursing Data Set 3rd version), that includes nursing diagnosis, interventions and outcomes, in clinical documentation demonstrating nursing’s contributions to patient outcomes. Notes: Demonstrate the nursing process is completed for each procedural intervention performed whether patient data is captured on paper or electronically.
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Category 6: Outcome Measurement—450 Points 13
This category focuses on the results achieved from your objective evaluation and patients/ family evaluations of perioperative services’ performance. Through measuring your progress, you can assess and improve processes related to clinical, staff, patient, and family outcomes.
For each question, reviewers will evaluate the data presented. Specifically, they are evaluating your current performance levels,1 trends over time,2 and results against comparable benchmarks.3 Although there are no requirements for the reporting time frame or amount of data you present, keep in mind that your results are used for performance management of your unit. Therefore, the measures you select to include should support decision making in a rapidly changing environment, and the measurement intervals should be appropriate for effective, timely, data-based decision making.
Notes: 1. Levels reflect numerical information that places or positions Perioperative Services’ results and performance on a meaningful measurement scale. 2. Trends are numerical information that shows the direction and rate of change. A statistically valid trend generally requires a minimum of three historical data points. 3. Comparisons are data points to evaluate perioperative services’ outcomes against similar external outcomes. Comparisons might include overall facility, regulatory requirements, external benchmarks or relevant nationally recognized standards. Some examples of recognized standards may include NDNQI, National Quality Forum (NQF), National Association of Children’s Hospitals and Related Institutions (NACHRI), and The Joint Commission (TJC). Criteria Questions 1 Summarize perioperative services key staffing effectiveness, staff safety, and staff satisfaction results. What are your current levels and trends in key measures? How do these results compare with the performance of similar organizations?
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2 What are your current levels and trends in key measures of patient and family satisfaction? How do these results compare with the performance of similar organizations?
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3 Summarize your key patient safety and clinical outcome results. What are your current levels and trends in key measures related to patient safety and clinical outcomes? How do these results compare with the performance of similar organizations? Notes: Responses to these questions must include quality indicators specific to the surgical patient population and scope of service. For example, the Surgical Care Improvement Project (SCIP) criteria (eg, antibiotic timing, antibiotic selection, beta-blocker administration, DVT prophylaxis, normothermia); appropriate hair removal; patient burns; unanticipated returns to surgery; surgical site infections; wrong site, wrong side, wrong patient, wrong procedure, wrong implant; patient flow indicators; adverse drug events; Central Line Associated Bloodstream Infections (CLABSI); Multi Drug Resistant Organisms (MDRO); Catheter Associated Urinary Tract Infections (CAUTI); glycemic control; patient falls, safe surgery checklist use, and pressure ulcers..
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4 Describe how outcome metrics are shared, who sees them, how they are communicated, and what changes are implemented via process improvement. Notes: Include levels and trends in your results and explanation of process improvement projects.
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Additional Information 1 Is there anything else that makes your department unique or that you are proud of that you would like 14
to share with the assessment team?
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