Develop a procedure book for your OR
The following are key words from standards and recommended practices of the Associa tion of Operating Room Nurses (AORN) in Denver that you could use to develop your facility's OR procedure book.
o Cleaning/processing anesthesia equipment
· Universal precautions
· Personal protective equipment use
· Use of specific facility-determined germicide or other disinfecting or sterilizing methods
o Aseptic technique
· Aseptic technique
· History of asepsis
· Current theories of asepsis
· The definition of a sterile field
o Surgical attire
· Surgical attire
· Cover gowns
· Hair covers
· Masks
· Jewelry
· Fingernails
· Personal protective equipment
o Chemical disinfection
· Selection of a germicide
· Necessity of following manufacturers' written recommendations on use and times
· Monitoring of product efficacy, personal protective wear, and environmental protection for staff members.
o Documentation of perioperative nursing care
· Record keeping
· Sample records that include evidence of assessment, nursing diagnoses, outcome identification, planning, implementation, and evaluation
o Electrosurgery
· Electrical safety
· Use of approved electrical equipment
· Appropriate biomedical maintenance of the electrosurgical units (ESUs) in use at your facility
· Documentation of skin at dispersive electrode site preoperatively and postoperatively
· Staff competency in the use of the ESUs
o Use and care of endoscopes
· Endoscope cleaning and sterilization or disinfection that reflects that the standard of care is the same for all patients in your facility
· Biomedical maintenance of endoscopes
· Use of personal protective equipment for use, leak testing, and staff member competency
o Endoscopic minimal access surgery
· Identification of all minimally invasive equipment in use in your facility
· How instruments are cleaned and sterilized or disinfected that reflects that the standard of care is the same for all patients
· Written instructions from the manufacturer on the cleaning, disassembly, care, and resterilization parameters of all instruments
· Staff member protection from smoke
· Decontamination of equipment
· Staff member competency
o Environmental responsibility in the practice setting
· Recycling of plastic bottles, paper wrappers
· Separation of infectious and noninfectious waste
o Use and selection of barrier materials for surgical gowns and drapes
· How the type of gown and drape is determined
· Rationale for use of different types of gowns for different types of procedures (e.g., cataract surgery vs. a cesarean procedure)
o Surgical hand scrubs
· How scrubs are performed based on appropriate data
· Reference to that data
o Safe care through the identification of potential hazards in the surgical environment
· Patient transfers
· Preventive maintenance performed on carts and OR beds
· The weight capacity of the OR bed and dealing with a patient who exceeds that capacity
· Use/temperature of blanket and fluid warmers
· Use of a microwave to warm fluids
· How to measure temperature of fluids before use
· Use of chemicals in OR and how to deal with a spill
· Occupational Safety and Health Administration and "right to know" manuals
· Tuberculosis control policy
· Disaster plans
o Care of instruments, scopes, and powered surgical instruments
· Enzyme cleaning solution for initial cleaning
· Personal protective equipment for cleaning instruments
· Ultrasonic cleaner
· Manufacturer's written instructions for disassembly of instruments
· Use of instrument lubricant
· Care and cleaning of powered surgical instruments (including lubrication requirements)
· Manufacturers' sterilization parameters
· Staff member competencies
o Monitoring the patient receiving IV conscious sedation
· Procedures for patients who choose conscious sedation
· Perioperative staff members' competencies for assisting with IV conscious sedation
· Monitoring requirements for patients
· Defining situations in which a monitor nurse and circulating and scrub nurses are needed
· Policies reflecting the need for the same level of care regardless of where in the facility the conscious sedation occurs
· Written discharge instructions
· Appropriate documentation
o Monitoring the patient receiving local anesthesia
· Monitoring requirements
· Competency level of the perioperative nurse performing the monitoring
· Defining situations in which skills greater than that of a perioperative nurse are needed
· Defining situations in which a monitor nurse and circulating and scrub nurses are needed
o Selection and use of packaging systems
· How your packaging systems are used
· Sterilization parameters for your system based on the manufacturer's recommendations
· How packages are wrapped
· Labeling parameters
· Event-related shelf life
o Use of pneumatic tourniquet
· How your specific tourniquet is used
· How often preventive maintenance is performed
· Documentation requirements
· Staff member competencies
o Positioning the patient in the perioperative practice setting
· Positions used in your OR
· Which positioning devices are available, and how they are used and maintained
· Documentation criteria for positions
· Preoperative and postoperative assessments
· Safety devices
o Product and medical device evaluation and selection for the perioperative practice setting
· How products are selected
· Sample evaluation form
o Reducing radiologic exposure in the practice setting
· Radiation safety procedures
· When badges, lead aprons, or other protective devices are used for staff members and patients
· Procedures for handling radioactive materials if these are used in your facility
o Sanitation in the surgical practice setting
· Use of personal protective equipment when cleaning
· Daily cleaning requirements
· End of procedure cleaning
· Terminal cleaning
· Housekeeping routine maintenance
o Skin preparation of patients
· Skin prep areas for specific procedures
· When hair removal is required, and how it is removed
· Documentation of the skin prep (including agent and preoperative/postoperative skin assessment)
o Sponge, sharp, and instrument counts
· What type of count is done, and for what type of procedure
· A sample count worksheet
· Documentation criteria for counts on the OR record
· Procedures for when counts are incorrect
o Sterilization in the practice setting
· Use of personal protective equipment for instrument cleaning
· Manufacturers' written parameters for the sterilizers in use at your facility
· Monitoring requirements and record keeping
· Labeling requirements
· Sterilizer preventive maintenance
· Staff member competencies in the use of any sterilizers
o Traffic patterns in the perioperative practice setting
· Traffic patterns in your OR
· Defining OR areas and required attire for those areas
· Flow of sterile supplies, contaminated supplies, and equipment, separating them by space, time, or traffic flow
o Universal precautions in the perioperative practice setting
· Procedures for universal precautions (may be in a facilitywide infection control manual)
· Required staff member testing and prophylaxis
POLICY AND PROCEDURES MANUAL COMPOSITION
The policy and procedures manual should include the following:
o general facility information;
o specific policy statements relating to the department's mission, function, staff members' competencies safety, disaster planning;
o AORN information (if used in the book's development);
o standardized forms;
o procedures arranged alphabetically or matched to the appropriate AORN recommended practice with alphabetical cross references.
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