online Learner Evaluation at http://www.aorn.org/CE. ... To educate perioperative nurses about providing safe nursing ..... First- and second-degree burns to.
CONTINUING EDUCATION Clinical Issues
1.2
SHARON A. VAN WICKLIN, MSN, RN, CNOR, CRNFA, CPSN, PLNC
www.aorn.org/CE Continuing Education Contact Hours
Approvals
indicates that continuing education contact hours are available for this activity. Earn the contact hours by reading this article, reviewing the purpose/goal, and completing the online Learner Evaluation at http://www.aorn.org/CE. Each applicant who successfully completes this program can immediately print a certificate of completion.
This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements. AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this activity for relicensure.
Event: #12516 Session: #0001 Fee: Members $6, Nonmembers $12 The contact hours for this article expire June 30, 2015.
Purpose/Goal To educate perioperative nurses about providing safe nursing care throughout the perioperative continuum.
Objectives 1. Discuss practices that could jeopardize safety in the perioperative area. 2. Discuss common areas of concern that relate to perioperative best practices. 3. Describe implementation of evidence-based practice in relation to perioperative nursing care.
Conflict of Interest Disclosures The author of this column has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article. The behavioral objectives for this program were created by Helen Starbuck Pashley, MA, BSN, RN, CNOR, clinical editor, with consultation from Susan Bakewell, MS, RN-BC, director, Perioperative Education. Ms Starbuck Pashley and Ms Bakewell have no declared affiliations that could be perceived as posing potential conflicts of interest in the publication of this article.
Sponsorship or Commercial Support No sponsorship or commercial support was received for this article.
Disclaimer Accreditation AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
AORN recognizes these activities as continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Credentialing Center approves or endorses products mentioned in the activity.
doi: 10.1016/j.aorn.2012.03.010
Ó AORN, Inc, 2012
June 2012
Vol 95 No 6
AORN Journal j 815
CLINICAL ISSUES
1.2
www.aorn.org/CE
This Month Using prepared endotracheal tubes Key words: endotracheal tubes, ETTs, prepared endotracheal tubes.
Surgical hand antisepsis using plain soap Key words: plain soap, antimicrobial soap, surgical hand antisepsis, surgical hand scrub.
Working with an impaired team member Key words: impaired health care provider, substance abuse, patient advocate.
Using warmed irrigation fluids during arthroscopy procedures Key words: irrigation fluid, warmed fluids, arthroscopy, burns.
Using prepared endotracheal tubes QUESTION: To be fully prepared for an emergency intubation, our anesthesia professionals use an intubation cart with several different sizes of prepared endotracheal tubes (ETTs) stored on the top of the cart. In the preparation process, the person preparing the ETTs removes them from their sterile packages, tests the integrity of the cuffs, places stylets, molds the tubes into the desired shape for intubation, and stores them on top of the intubation cart. Do these prepared ETTs present a potential for patient infection? How often should the tubes be replaced with new ones? ANSWER: There is no evidence that using prepared ETTs increases the risk of infection in healthy adult patients. In one study, researchers cultured 30
prepared ETTs that had been stored for a threeday period in the resuscitation bays of a hospital emergency department.1 Although they recovered coagulase-negative staphylococci from 15 of the tubes, no virulent pathogens were isolated from any of the airway equipment stored in the resuscitation bays. The researchers determined that the coagulase-negative staphylococci were probably shed from the skin of personnel preparing, checking, or using the equipment. They also concluded that the practice of using prepared airway equipment is not likely to contribute to the development of a health care-associated pneumonia.1 In another study, researchers placed prepared ETTs in 20 different locations, including ORs, labor and delivery rooms, and epidural carts.2 They cultured the tubes at eight different time intervals during a four-week period and cultured nonvirulent doi: 10.1016/j.aorn.2012.03.010
816 j AORN Journal
June 2012
Vol 95
No 6
Ó AORN, Inc, 2012
CLINICAL ISSUES bacteria from 13 of the 160 samples tested. The researchers concluded that the pathogenic potential of prepared ETTs is very small, and the tubes may be safely used and stored for up to one month.2 In a study that involved 50 prepared ETTs and was conducted in the emergency department of a Level I trauma center, researchers cultured the tubes at six, 12, 24, 36, and 48 hours. The results showed no statistically significant increase in the incidence of bacterial contamination of the prepared ETTs.3 The researchers concluded that it was safe to use ETTs that had been prepared less than 48 hours before use.3 These studies1-3 demonstrated limited bacterial contamination of prepared ETTs; however, it is important to consider the clinical implications of using prepared ETTs in patients who may be at increased risk for infection, such as neonates, patients who are immunocompromised, or patients who require long-term intubation. In a study that investigated the contamination rates of 19 prepared neonatal ETTs randomly collected and cultured from resuscitation carts located in delivery rooms on four different days during a three-week period, researchers found that bacteria were present on 15 of the 19 tubes cultured. Coagulase-negative staphylococci was the most frequently identified organism.4 Although of little significance in healthy adult patients, infection with coagulasenegative staphylococci can result in serious morbidity and mortality in the neonatal patient.5,6 Likewise, introducing pathogens from the environment into a critically ill patient who has inadequate defense mechanisms or whose defense mechanisms have been altered by concomitant antibiotic therapy could be catastrophic.7 It may be prudent, therefore, to prepare the ETT immediately before use and avoid the use of previously prepared ETTs in patients with reduced ability to resist infection.5-7 When making decisions regarding the use of prepared ETTs, a multidisciplinary team of stakeholders including personnel from the anesthesia, infection prevention, perioperative services, quality
www.aornjournal.org
improvement, and risk management departments should examine the evidence regarding prepared ETT use, evaluate the patient population the tubes will be used for, and review other critical needs (eg, incidence of emergent intubation) to determine facility policy. These policies and procedures should be developed using an organization-wide process, reviewed periodically, and be readily available in the practice setting. Policies and procedures should provide clear guidelines and establish responsibility for the practice of using prepared ETTs and should include the n n n n n n n
method for preparing ETTs, sizes and number of tubes to be prepared, storage method for prepared tubes, location of prepared tubes, length of time tubes will be stored, method for indicating expiration dates, and disposition of expired tubes.
The policies and procedures should include a process that ensures the prepared ETTs are protected from intentional and nonintentional contamination, such as placing the prepared tubes in a sealed container. A quality management program should be in place to evaluate the practice of using prepared ETTs and to identify and respond to opportunities for improvement. SHARON A. VAN WICKLIN MSN, RN, CNOR, CRNFA, CPSN, PLNC PERIOPERATIVE NURSING SPECIALIST AORN CENTER FOR NURSING PRACTICE
References 1. Bleetman A, Ashwood N. Is it safe to use prepared endotracheal tubes in the resuscitation room? J Accid Emerg Med. 1996;13(4):283-284. 2. Rasic NF, Friesen RM, Anderson B, Hoban SA, Olson N, Kress J. Prepared endotracheal tubes: are they a potential source for pathogenic microorganisms? Anesth Analg. 2003;97(4):1133-1136. 3. Browder WD, Cromer MP, Counselman FL. Open endotracheal tubes may be safely left on an ED airway cart for 48 hours. Am J Emerg Med. 2005;23(4): 548-551.
AORN Journal j 817
June 2012
CLINICAL ISSUES
Vol 95 No 6
4. Walsh JA, Walsh ME, Knowles SJ, O’Donnell CP. Bacterial colonisation of previously prepared neonatal endotracheal tubes in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2008;93(6):F475-F476. 5. Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD neonatal research network. Pediatrics. 2002; 110(2 Pt 1):285-291.
6. Winckworth LC, Bhatt RM. Does pre-preparing endotracheal tubes increase the risk of contamination with potentially pathogenic bacteria? J Paediatr Child Health. 2011;47(5):310-313. 7. Cheung N, Betro G, Luckianow G, Napolitano L, Kaplan LJ. Endotracheal intubation: the role of sterility. Surg Infect. 2007;8(5):545-552.
Surgical hand antisepsis using plain soap QUESTION: Before donning sterile gown and gloves, one of our older surgeons uses plain soap (ie, a bar of soap) to perform surgical hand antisepsis. Is this acceptable? ANSWER: Plain soap should not be used for surgical hand antisepsis. Before donning a sterile gown and gloves, surgical team members should perform a surgical hand scrub using either an antimicrobial surgical scrub agent intended for surgical hand antisepsis or an alcohol-based surgical hand rub with documented persistent and cumulative antimicrobial activity that has met US Food and Drug Administration regulatory requirements for surgical hand antisepsis.1 Normal skin flora of the hands includes both transient and resident microorganisms.2 Transient flora are composed of microorganisms that colonize the superficial layers of the skin.3,4 In a health care setting, transient flora are acquired by personnel during patient care and by contact with contaminated environmental surfaces. These are the organisms most commonly associated with health care-associated infections.3,4 Transient flora are generally removed by effective handwashing.3,4 Resident flora are seated more deeply under the superficial layers of the stratum corneum and are more difficult to remove.3,4 Resident flora are less likely to be associated with health care-associated infections but may cause infections in sterile body cavities, the eyes, or nonintact skin.3,4 The purpose of a surgical hand scrub is to eliminate transient flora and reduce resident flora.1
818 j AORN Journal
Plain soaps are effective in removing dirt, soil, various organic substances, and transient flora from the hands; however, they have limited antimicrobial activity and do not substantively reduce resident flora.3,4 According to the Centers for Disease Control and Prevention,3 n
plain soap is a detergent that contains no antimicrobial agents or contains very low amounts of antimicrobial agents that are used as preservatives,3 and n antimicrobial soap contains a sufficient quantity of an antiseptic agent to inactivate or temporarily suppress the growth of microorganisms.3 In 1847, Ignaz Semelweiss, a Hungarian physician, demonstrated that mortality rates were significantly lowered when hospital personnel used an antiseptic agent rather than plain soap and water to wash their hands.5 Other studies have demonstrated that plain soap may fail to remove pathogens from the hands of hospital personnel6-8 and can result in paradoxical increases in bacterial counts on the skin.9-12 Plain soap also has been associated with significant skin dryness and irritation.9,11,12 Soap can become contaminated over time and colonize the hands of personnel who use it with gram-negative bacteria13; however, the potential for transmission of organisms after handwashing with previously used soap appears to be negligible.14,15 The US Food and Drug Administration recommends that agents used for surgical hand antisepsis should reduce the number of microorganisms on intact skin, contain a nonirritating antimicrobial formulation, have broad-spectrum activity, and be
CLINICAL ISSUES fast acting and persistent.16 Antiseptic products intended for use as surgical hand scrubs are evaluated for their ability to reduce the number of bacteria on the hands immediately after scrubbing, after wearing surgical gloves for six hours (ie, persistent activity), and after multiple applications over five days (ie, cumulative activity).16 Immediate and persistent activity are considered to be the most important factors in determining the efficacy of products used for surgical hand antisepsis.3 SHARON A. VAN WICKLIN MSN, RN, CNOR, CRNFA, CPSN, PLNC PERIOPERATIVE NURSING SPECIALIST AORN CENTER FOR NURSING PRACTICE References 1. Recommended practices for hand hygiene in the perioperative setting. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2012:73-86. 2. Price PB. The bacteriology of normal skin: a new quantitative test applied to a study of the bacterial flora and the disinfectant action of mechanical cleansing. J Infect Dis. 1938;63(3):301-318. http://jid.oxfordjournals .org/content/63/3/301.full.pdfþhtml?ijkey¼9a0794761ff 43ff67879b3d7d99899d0bd12f531&keytype2¼tf_ipsecsha. Accessed January 17, 2012. 3. Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR. October 25, 2002;51(RR16):1-44. http://www.cdc.gov/mmwr/preview/mmwrhtml/ rr5116a1.htm. Accessed January 17, 2012. 4. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge. Clean Care is Safer Care. Geneva, Switzerland: World Health Organization; 2009. http://whqlibdoc.who.int/publicatio
www.aornjournal.org
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15. 16.
ns/2009/9789241597906_eng.pdf. Accessed January 17, 2012. Larson E. A causal link between handwashing and risk of infection? Examination of the evidence. Infect Control Hosp Epidemiol. 1988;9(1):28-36. Ehrenkranz NJ, Alfonso BC. Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters. Infect Control Hosp Epidemiol. 1991;12(11):654-662. McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989;320(4):204-210. Bottone EJ, Cheng M, Hymes S. Ineffectiveness of handwashing with lotion soap to remove nosocomial bacterial pathogens persisting on fingertips: a major link in their intrahospital spread. Infect Control Hosp Epidemiol. 2004;25(3):262-264. Larson E, Leyden JJ, McGinley KJ, Grove GL, Talbot GH. Physiologic and microbiologic changes in skin related to frequent handwashing. Infect Control. 1986;7(2):59-63. Meers PD, Yeo GA. Shedding of bacteria and skin squames after handwashing. J Hyg (Lond). 1978;81(1): 99-105. Winnefeld M, Richard MA, Drancourt M, Grobb JJ. Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use. Br J Dermatol. 2000;143(3):546-550. Boyce JM, Kelliher S, Vallande N. Skin irritation and dryness associated with two hand-hygiene regimens: soap and water hand washing versus hand antisepsis with an alcohol gel. Infect Control Hosp Epidemiol. 2000;21(7): 442-448. Sartor C, Jacomo V, Duvivier C, Tissot-Dupont H, Sambuc R, Drancort M. Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap. Infect Control Hosp Epidemiol. 2000;21(3):196-199. Heinze JE, Yacovich F. Washing with contaminated bar soap is unlikely to transfer bacteria. Epidemiol Infect. 1988;101(1):135-142. Bannan EA, Judge LF. Bacteriological studies relating to handwashing. Am J Public Health. 2002;55:915-922. US Food and Drug Administration. 21 CFR Part 333 and 369dTopical antimicrobial drug products for overthe-counter human use. Fed Regist. 1994;59(116): 31441-1452.
Working with an impaired team member QUESTION: Recently, when I was called in to assist with an emergency surgical procedure, I noticed one of my coworkers was glassy-eyed and appeared to be under the influence of alcohol. When I asked whether she was okay, she stated that she was “just fine.” She was able to function, but was
a bit unsteady on her feet. I was concerned about allowing the procedure to begin, but not sure what to do. What should I have done? ANSWER: As an advocate for the patient, perioperative nurses have an ethical obligation to report colleagues AORN Journal j 819
June 2012
CLINICAL ISSUES
Vol 95 No 6
whose actions could harm patients. According to the American Nurses Association’s Code of Ethics for Nurses, “Nurses must be vigilant to protect the patient, the public, and the profession from potential harm when a colleague’s practice, in any setting, appears to be impaired.”1(p15) Nurses who observe behavior indicating that any member of the perioperative team may be under the influence of alcohol or drugs or may be experiencing a personal health crisis, such as an untoward reaction to prescribed medication or a diabetic hypoglycemic event, must immediately report their concerns to the appropriate administrative personnel.1 The nurse may also want to consider approaching the individual in a supportive manner and helping the individual to access available resources.1 The administrator should take immediate action to protect the patient1 by removing the individual from the patient care environment and providing a replacement caregiver. The administrator should also obtain appropriate assistance for the individual.1 Nurses may feel uncomfortable about reporting a colleague they suspect of being impaired and may choose to remain silent; however, the consequences of not reporting these concerns could be severe. Impaired health care providers can seriously harm patients as well as the reputation of the facility, the health care profession, and themselves.2 Nurses cite fear of being labeled a tattletale or a hypocrite or reluctance to jeopardize a colleague’s position or
license as reasons for their failure to report impaired team members.2 Patients, however, have a right to receive safe, skilled care from health care providers who are mentally alert and physically capable of providing the requisite care. In a situation in which a nurse believes a team member may be impaired, he or she has a duty to take action to protect the patient and to ensure that the impaired person is prevented from providing care and receives assistance.1 Addiction must be understood as an illness that requires treatment. When viewed in that light, health care providers can help one another recognize the signs and symptoms of impairment and identify impaired colleagues and ensure that they receive treatment.2 Health care organizations should provide mechanisms that allow for confidential reporting and tracking of potential substance abuse issues and should also provide education and support to help nurses and other health care providers participate in rehabilitation activities if needed.1,2 SHARON A. VAN WICKLIN MSN, RN, CNOR, CRNFA, CPSN, PLNC PERIOPERATIVE NURSING SPECIALIST AORN CENTER FOR NURSING PRACTICE References 1. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: American Nurses Association; 2001. 2. Dunn D. Substance abuse among nursesddefining the issue. AORN J. 2005;82(4):572-596.
Using warmed irrigation fluids during arthroscopy procedures QUESTION: What should the temperature be for irrigation fluids used during arthroscopy procedures? ANSWER: Fluids used for irrigation in the body should not exceed 98.6 F (37 C) or approximate normal body temperature.1,2 Moritz and Henriques3 used pigs and human participants to ascertain 820 j AORN Journal
the effects of flowing heated water on the skin. After prolonged exposure (ie, four hours) to fluid temperatures as low as 111 F (44 C), first-degree burns occurred on the pig skin; however, when the fluid temperature was increased to 126 F (52 C), second-degree burns appeared after only 90 seconds. First- and second-degree burns to human participants occurred at temperatures of 117 F (47 C) after 18 to 40 minutes. When the
CLINICAL ISSUES temperature was raised to 124 F (51 C), firstand second-degree burns occurred after only two to six minutes.3 Thermal injuries have occurred as a result of overheated irrigation fluids. In one report describing a 28-year-old man undergoing an anterior cruciate ligament reconstruction, the surgeon infused the patient’s knee with normal saline irrigation that had been heated in a warming cabinet that was also used to heat blankets.4 Sample temperatures of the fluid stored in the cabinet ranged from approximately 118 F (48 C) to 126 F (52 C).The tourniquet time for the procedure was 110 minutes. The surgeon used a total of 24 L of irrigation fluid during the procedure. When the surgeon removed the dressing on the first postoperative day, the patient had an area of erythema and blistering on the anteromedial aspect of the calf approximately 7 cm wide. The patient’s burn was treated, and the burned area resolved without further complication. The authors of this report recommended against the use of warmed irrigation fluid in arthroscopy procedures but suggested that if warmed fluids are used, the temperature and exposure time should be monitored.4 In another case study involving a 46-year old man undergoing reconstructive knee arthroscopy, the surgeon irrigated the patient’s knee with approximately 2 L of fluid.5 The surgeon observed that the fluid was hot to the touch and immediately flushed the patient’s knee with cold fluid. Perioperative personnel discovered the warming cabinet temperature to be 101 F (38 C) in the upper compartment and 119 F (48 C) in the lower compartment. On postoperative days one to three, the surgeon noted the patient’s leg had blisters along the area where the irrigation fluid had flowed. On postoperative day 10, the patient fell at home. When the patient was seen in the emergency department, the burned area was oozing and sloughing. The surgeon performed an arthroscopic irrigation on postoperative day 14, which revealed purulent fluid, fibrous tissue formation, and full-thickness
www.aornjournal.org
burns to the skin. The patient underwent multiple debridement and reconstructive procedures and was ultimately discharged on postoperative day 48 for further rehabilitation. The authors of the case study point out that there is increased potential for cartilaginous tissue damage when the tissue is exposed to heat because of the reduced number of blood vessels in cartilage. They suggested that fluids used during arthroscopy procedures be monitored for appropriate temperatures before use.5 In a study designed to determine the effects of irrigation fluids at various temperatures on the surface of articular cartilage, researchers used an electron microscope to determine the effect of two hours of 200 mL/hour irrigation with normal saline at three temperatures (39 F [4 C], 77 F [25 C], and 98.6 F [37 C]) on the knee joints of 30 rats.6 The researchers concluded that using cold irrigation fluid (39 F [4 C]) may lead to articular surface injury; conversely, using irrigation fluid at approximately normal body temperature (98.6 F [37 C]) may help to reduce articular surface damage.6 Cool irrigation in body cavities also may enhance heat transfer from the body core to the solution and increase the risk of heat loss.7 Although insufficient to prevent hypothermia, warming irrigation fluid to near body temperature (98.6 F [37 C]) is an adjunct therapy that may decrease heat loss.7 SHARON A. VAN WICKLIN MSN, RN, CNOR, CRNFA, CPSN, PLNC PERIOPERATIVE NURSING SPECIALIST AORN CENTER FOR NURSING PRACTICE
References 1. Recommended practices for a safe environment of care. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2012:215-236. 2. Limiting temperature settings on blanket and solution warming cabinets can prevent patient burns [Problem Reports]. Health Devices. 2005;34(5):168-171. 3. Moritz AR, Henriques FC. Studies of thermal injury: II. The relative importance of time and surface temperature in the causation of cutaneous burns. Am J Pathol. 1947;23(5): 695-720.
AORN Journal j 821
June 2012
CLINICAL ISSUES
Vol 95 No 6
4. Sheskier SC, Fu FH. Arthroscopic irrigation burn. A case report. Am J Sports Med. 1991;19(2):191-193. 5. Huang S, Gateley D, Moss ALH. Accidental burn during knee arthroscopy. Arthroscopy. 2007;23(12):1363.e1-1363.e3. 6. Cheng SC, Jou IM, Chern TC, Wang PH, Chen WC. The effect of normal saline irrigation at different temperatures
on the surface of articular cartilage: an experimental study in the rat. Arthroscopy. 2004;20(1):55-61. 7. Recommended practices for the prevention of unplanned perioperative hypothermia. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2012:365-378.
The author of this column has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
Clinical Questions? AORN Has the Answers AORN’s dedicated team of perioperative nursing specialists has developed online resources to address many of your clinical questions, including, but not limited to: n Clinical Answers (www.aorn.org/clinicalanswers) n Tool Kits (www.aorn.org/toolkits) n Position Statements (www.aorn.org/AORNPositionStatements) n Recommended Practices (www.aorn.org/AORNRecommendedPractices) n Clinical Issues column in the AORN Journal (www.aornjournal.org/content/colle
ction_clinical) n Recommended Practices Implementation Articles (www.aornjournal.org/content/
collection_recommended_practices) For answers to your clinical questions, look to AORN. We are here to support you in your perioperative practice.
822 j AORN Journal
LEARNER EVALUATION
1.2
CONTINUING EDUCATION PROGRAM
Clinical Issues
T
his evaluation is used to determine the extent to which this continuing education program met your learning needs. The evaluation is printed here for your convenience. To receive continuing education credit, you must complete the Learner Evaluation online at http://www.aorn.org/CE. Rate the items as described below. PURPOSE/GOAL To educate perioperative nurses about providing safe nursing care throughout the perioperative continuum. OBJECTIVES To what extent were the following objectives of this continuing education program achieved? 1. Discuss practices that could jeopardize safety in the perioperative area. Low 1. 2. 3. 4. 5. High 2. Discuss common areas of concern that relate to perioperative best practices. Low 1. 2. 3. 4. 5. High 3. Describe implementation of evidence-based practice in relation to perioperative nursing care. Low 1. 2. 3. 4. 5. High CONTENT 4. To what extent did this article increase your knowledge of the subject matter? Low 1. 2. 3. 4. 5. High 5. To what extent were your individual objectives met? Low 1. 2. 3. 4. 5. High
Ó AORN, Inc, 2012
www.aorn.org/CE
6. Will you be able to use the information from this article in your work setting? 1. Yes 2. No 7. Will you change your practice as a result of reading this article? (If yes, answer question #7A. If no, answer question #7B.) 7A. How will you change your practice? (Select all that apply) 1. I will provide education to my team regarding why change is needed. 2. I will work with management to change/ implement a policy and procedure. 3. I will plan an informational meeting with physicians to seek their input and acceptance of the need for change. 4. I will implement change and evaluate the effect of the change at regular intervals until the change is incorporated as best practice. 5. Other: _______________________________ 7B. If you will not change your practice as a result of reading this article, why? (Select all that apply) 1. The content of the article is not relevant to my practice. 2. I do not have enough time to teach others about the purpose of the needed change. 3. I do not have management support to make a change. 4. Other: _______________________________ 8. Our accrediting body requires that we verify the time you needed to complete the 1.2 continuing education contact hour (72-minute) program: _________________________________
June 2012
Vol 95 No 6
AORN Journal j 823
