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AORN is committed to promoting excellence in perioperative nursing practice, advancing the profession, and supporting the professional perioperative registered nurse (RN). AORN promotes safe care for patients undergoing operative and other invasive procedures by creating this collection of evidence-rated perioperative guidelines. The descriptive and comprehensive documents in this publication reflect the perioperative RN’s scope of professional responsibility. The guidelines are intended to be achievable and represent what is believed to be an optimal level of patient care and workplace safety. Each guideline contains recommendations that are broad statements to be used to guide the development of policies, procedures, and criteria for measuring individual competency in a variety of practice settings. These guidelines represent AORN’s official position on questions regarding perioperative practice, and they have been approved by the AORN Guidelines Advisory Board.

Evidence-based practice is essential to improving patient care by promoting decisions based on evidence rather than on the opinion of an individual health care professional. The AORN guidelines are based on a comprehensive, systematic review of research and non-research evidence; the individual references are appraised and scored, and the recommendations are rated according to the strength and quality of the evidence supporting each recommendation. When adhering to the AORN Guidelines for Perioperative Practice, perioperative clinicians can be confident that they are following trustworthy guidelines developed in accordance with the principles set forth by the National Academy of Medicine.1

Perioperative practice specialists in the AORN Nursing Department author the guidelines with assistance from members of the AORN Guidelines Advisory Board and interdisciplinary collaboration with liaisons representing the American Association of Nurse Anesthetists, the American College of Surgeons, the American Society of Anesthesiologists, the Association for Professionals in Infection Control and Epidemiology, the International Association of Healthcare Central Service Materiel Management, the Society for Healthcare Epidemiology of America, and the Surgical Infection Society.

Each guideline is posted for a 30-day public comment period at http://www.aorn.org. The public comments are individually reviewed and reconciled by the guideline team members. Each guideline is reviewed and updated on a 5-year cycle. Because only a portion of the guidelines are updated for publication in any given year, differences in format, content organization, and design may occur. As used within the context of the guidelines, the word “should” indicates that a certain course of action is recommended. “Must” is used only to describe requirements mandated by government regulation. Use of “may” indicates that a course of action is permissible within the limits of the guideline, and "can" indicates possibility and capability.

New in this Edition

The 2020 edition of this book includes six new evidence-rated guidelines:

  • Autologous Tissue

  • Environmental Cleaning

  • Hypothermia

  • Packaging Systems

  • Sharps Safety

  • Surgical Attire

Evidence Appraisal and Rating

Each guideline focuses on a specific question or topic. A clinical research librarian employed by AORN conducts a systematic literature search to identify meta-analyses, randomized and nonrandomized trials and studies, systematic and nonsystematic reviews, and opinion documents and letters related to the topic. The Hierarchy of Evidence (Appendix A) is a visual depiction of the types of evidence used in the AORN Guidelines and demonstrates the strongest to the weakest types of evidence.

The lead author and an appraiser independently evaluate and critically appraise the strength and quality of the evidence using the AORN Evidence Appraisal Tools (See Appendix B, Appendix C, and Appendix D). Each article or study is assigned a consensus appraisal score as agreed upon by the reviewers. Each appraisal score includes a Roman numeral (ie, I, II, III, IV, or V) and an alphabetical character (ie, A, B, or C). The Roman numeral represents the level of strength, and the alphabetical character represents the level of quality (eg, IIA). The appraisal scores of individual references are noted in brackets after each citation in the references section of the guideline as applicable.

After the evidence is individually appraised, the evidence supporting each recommendation is synthesized and rated as high-, moderate-, or low-quality using the AORN Evidence Rating Model (See Appendix E). The strength of the recommendation is rated based on the evidence rating, a benefit-harm assessment, and consideration of resource use. The recommendations in each guideline are given one of the following ratings:

  • [Regulatory Requirement]

  • [Recommendation]

  • [Conditional Recommendation]

  • [No Recommendation]

The recommendation strength rating is noted in brackets after each recommendation.

DOCUMENT STRUCTURE

Topic Headings - Headings that represent the general subject of each section. The topic heading is in a large, bold font is identified by a number (eg, 1).

Recommendations - Specific recommendations for treatment or action. Recommendations are identified by a number after the topic heading number (eg, 1.1). The recommendation statement is followed by a rationale detailing the evidence that supports the recommendation. The strength of each recommendation is rated using the AORN Evidence Rating Model and is noted in brackets after the recommendation statement (eg, [Recommendation]).

Activities - Statements that describe the actions necessary to implement the recommendation. Activities are noted by a number following the topic heading number and the recommendation number (eg, 1.1.1). The strength of each activity is rated using the AORN Evidence Rating Model, and is noted in brackets after the activity statement (eg, [Conditional Recommendation]).

Glossary - A list of definitions for terms used in the document with which the reader may be unfamiliar. Glossary terms are in a bold font in the text for easy identification. The definitions are located at the end of the guideline before the References.

References - A list of all references used within the document and the assigned appraisal scores. The appraisal score is noted in brackets after each citation (eg, [IA]).

Ambulatory Supplements - Each document is reviewed and vetted for applicability to ambulatory surgery centers, and supplemental information is provided related to recommendations that may have additional considerations for these perioperative practice settings. The Ambulatory Supplements are intended to be used as additional information for the perioperative RN practicing in a free-standing ambulatory surgery center or a physician office-based surgery center. A link in the text of a guideline indicates that there is additional information in the Ambulatory Supplement. Relevant text from the guideline is repeated in the Supplement for easy reference and to give context to the ambulatory considerations.

The Ambulatory Supplement is an adjunct to the guideline on which it is based and is not intended to be a replacement for that document. Perioperative personnel who are developing and updating organizational policies and procedures should review and cite the full guideline.

AORN Guidelines and the PNDS

The Perioperative Nursing Data Set (PNDS) is the standardized nursing language developed and refined by AORN and recognized by the American Nurses Association to describe the nursing care, from preadmission to discharge, of patients undergoing operative or other invasive procedures.2 The PNDS enables nursing care to be documented in a standardized manner and allows the collection of reliable and valid comparable clinical data to evaluate the effectiveness of nurse-sensitive interventions and the relationship between these interventions and patient outcomes. The Guidelines for Perioperative Practice is the foundation of clinical knowledge from which the PNDS is derived. The Guidelines for Perioperative Practice and the PNDS concepts are mapped to the clinical content within the AORN Syntegrity® perioperative documentation solution for the electronic health record. The AORN Syntegrity solution provides standardized content for electronic perioperative nursing documentation. The PNDS is distributed only through an AORN Syntegrity license. To learn more about the AORN Syntegrity solution and implementation of the PNDS within the electronic health record, contact the AORN Syntegrity team via e-mail at syntegrity@aorn.org or visit http://www.aorn.org/syntegrity.

Implementation in Practice

Individual commitment, professional conscience, and the setting in which perioperative nursing is practiced should guide the RN in implementing these guidelines. Implementation of the guidelines in perioperative settings requires close examination of existing policies and procedures. This review may indicate that new or revised policies and procedures are needed. Although the guidelines are considered to represent the optimal level of practice, variations in practice settings and clinical situations may limit the degree to which each guideline can be implemented. AORN has created a comprehensive set of implementation tools to help health care organizations implement the guidelines. For more information, visit http://www.aorn.org.

References

  • 1. 
  • Institute of Medicine. Field  MJ, Lohr  KN, eds. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: National Academy Press; 1990:38.
  • 2. 
  • Petersen  C, ed. Perioperative Nursing Data Set. 3rd ed. Denver, CO: AORN, Inc; 2011.

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