EORNA Best Practice for perioperative care First edition March 2015 Second edition November 2020 ©The European Operating Room Nurses Association (EORNA) claims copyright ownership of all information in the EORNA Position statements and Guidelines for Perioperative Nursing Practice Part 1, unless stated otherwise. WWW.EORNA.EU 1 No responsibility is assumed by EORNA for any injury and/or damage to persons or property as a matter of products liability, negligence, or otherwise, or from any use or operation of any standards, guidelines, recommendations, methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the health care sciences, independent verification of diagnoses, medication dosages, and individualized care and treatment should be made. 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This book is sold subject to the condition that it shall not, by way of trade or otherwise be lent, re-sold, hired out or otherwise circulated without the author’s prior consent in any form of binding or cover other than that in which it is published and without a similar condition including this condition being imposed on the subsequent purchaser. Publisher: The European Operating Room Nurses Association (EORNA), Brussels, Belgium www.eorna.eu ISBN: 9789082370904 WWW.EORNA.EU 2 EORNA best practice for Perioperative care The recommended practices are developed with the purpose to provide guidelines for perioperative nurses in their nursing care in relation to surgery to achieve patient safety. The recommended practice is aimed for perioperative nurses in countries in Europe, and internationally. Nurses’ code of ethics (ICN, 2012), nurses’ specialist framework (ESNO, 2015), nurses’ core competences (QSEN, 2003; Cronenwett et al., 2007; Cronenwett, 2009) and description of competence (EORNA, 2019) are important fundamental documents according to the recommendations. Intentions with the recommendations are that every unique patient should be offered safe perioperative nursing care from the perspective of evidence-based nursing by all co-workers and members in the surgical team. These recommendations may be of advantage for practice in healthcare and especially in the operating rooms. EORNA recognizes the various settings in which surgical procedures are performed and where perioperative nurses' practices. The recommendation was developed by the EORNA Perioperative Nursing Care Committee. WWW.EORNA.EU 3 PNC committee members 2012-2021 The members of the Perioperative The members of the Perioperative Nursing care committee 2012-2015 Nursing care committee 2015-2017 Sandra Morton (Ireland) -PNC Chair Annika Sandelin (Sweden) -PNC Chair Committee members Committee members Britta Nielsen (Denmark) Aliya Okgün Alcan (Turkey) Annika Sandelin (Sweden) Catherine Heen (Norway) Dimitris Poulis (Greece) Britta Nielsen (Denmark) Catherine Heen (Norway) Filiz Ogce (Turkey) Dimitris Poulis (Greece) Ivanka Budiselić- Vidaic (Croatia) Mirella Lepore , Luciano Trozzi (Italy) Michael Elin (Israel) Panayota Mylona (Cyprus) Panayota Mylona (Cyprus) Tiiu Koemets (Estonia) Sandra Morton (Ireland) Valentina Sarkisova (Russia) Vivi-Ann Sandersen (Norway) The members of the Perioperative The members of the Perioperative Nursing care committee 2017-2019 Nursing care committee 2019-2021 Cathrine Heen (Norway) -PNC chair Michael Elin (Israel) - PNC Chair committee members committee members Annica Sandelin (Sweden) Filiz Ogce (Turkey) Dori Afraie (France) Ivanka Budiselić- Vidaic (Croatia) Ivanka Budiselic – Vidaic (Croatia) Kate Furbur (France) Michael Elin (Israel) Marin Repustić (Croatia) Mirella Lepore (Italy) Mirella Lepore (Italy) Panayota Mylonas (Cyprus) WWW.EORNA.EU 4 Table of contents 1. Perioperative care practices…………………………………….... pages 7-14 1.1 Theory of Anticipatory Vigilance – A Theory for Perioperative Nurses 1.2 EORNA best practice for evidence-based practice 1.3 EORNA best practice for safe staffing for perioperative departments 1.4 EORNA best practice for free movement of professionals ( Directive 2005/36/ECF) 1.5 EORNA best practice for post graduate nurse education 2. Patient and staff safety……………………………………………pages 15-85 2.1 EORNA best practice for surgical drapes and gowns (standard EN 13795) 2.2 EORNA best practice n for prevention of sharps injuries (2010/32/EU). 2.3 EORNA support the WHO recommendation - The use of the safe surgery checklist 2.4 EORNA best practice on prevention of inadvertent retained surgical items 2.5 EORNA best practice ion for safe positioning of patients 2.6 EORNA best practice for maintaining normothermia 2.7 EORNA best practice for safe management of tourniquets 2.8 EORNA best practice for protection and prevention of surgical smoke 2.9 EORNA best practice for ventilation in operating room 2.10 EORNA best practice for electrosurgical safety in operating room 2.11 EORNA best practice for Laser safety 2.12 EORNA best practice for specimen management 2.13 EORNA best practice for natural rubber Latex allergy 2.14 EORNA best practice for chemical safety in operating room 2.15 EORNA best practice for radiation safety in operating room 3. Infection control in the operating room…………………….pages 86 -117 3.1 EORNA best practice for standard precautions 3.2 EORNA best practice for infection prevention 3.3 EORNA best practice for skin preparation and draping 3.4 EORNA best practice for aseptic technique 3.5 EORNA best practice for hand hygiene 3.6 EORNA best practice for gowning and gloving 3.7 EORNA best practice for perioperative attire (need to revise ) 4. Pandemic disasters………………………………………….pages 118-128 4.1 EORNA best practice for Ebola (Viral Hemorrhagic Fever) 4.2 EOENA best practice for COVID 19 in operating room. WWW.EORNA.EU 5 Part 1 Perioperative care practices WWW.EORNA.EU 6 Theory of Anticipatory Vigilance – A Theory for Perioperative Nurses Perioperative nursing as a profession is central to effective health service delivery for the surgical patient (Rothrock, 2011). The perioperative environment is in a constant state of change in a climate of safety, risk management, professionalism, accountability, and consumerism, which influence nurses working in the perioperative setting. An ability to work within an increasing range of technology while providing and overseeing the provision of patient care to the surgical patient is essential in reducing risk and promoting patient safety. Maintaining a safe environment is dependent on the perioperative nurse maintaining an optimal level of practice, encompassing moral, legal standards, education, autonomy, accountability, decision making, ethical standards, management, and leadership (AORN 2012). Patient safety and risk management is now both an international and global priority (Battles & Lilford 2003) where the goal is to lessen the possibility of injury or risk to patients within the structure and processes of care given. Safety is a complex multifaceted phenomenon, yet it is essential that all perioperative nurses must understand and possess the skills to ensure that patients are not exposed to error. Providing safe care is a primary role of the perioperative nurse (O’ Brien 2012, AORN 2014). A rich source of information regarding safety within the perioperative setting can be obtained from the nurses who work there daily. They need to be more aware of their role in minimizing risk in the perioperative setting. The doctoral study on: ‘Anticipatory Vigilance: A classic grounded theory of risk reduction and management in the perioperative setting’ aimed to achieve this. This perioperative nursing theory explains the main behaviors and attitudes of nurses working in the perioperative setting when minimizing risk. The Theory of Anticipatory Vigilance The nurses’ main concern of minimizing risk in this high risk, highly structured setting, ensuring safety is related to achieving a positive and successful experience for all patients in their care before, during and after surgery. Anticipatory vigilance is how perioperative nurses minimize risk in this setting. Anticipatory vigilance refers to the strategies that perioperative nurses use to resolve their main concern of minimizing risk in the perioperative setting. Nurses engage in and practice anticipatory vigilance in three ways, through orchestrating, routinizing and momentary adapting. These are intrinsically linked through trusting relations. Each category has a related dependency on one another in assisting and shaping the theory of anticipatory vigilance. Trusting relations is a necessary precondition for minimizing risk through anticipatory vigilance. It underpins the process of orchestrating, routinizing and momentary adapting.