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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 through the creation and maintenance of this collection of evidence-based perioperative guidelines. The descriptive and comprehensive guidelines in this collection reflect evidence-based practices for the perioperative RN. Each AORN guideline includes recommendations intended to be achievable and to represent what is believed to be an optimal level of perioperative 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 where operative and other invasive procedures are performed. Together with the Perioperative Nursing: Scope and Standards of Practice,1 these guidelines represent AORN’s official position on questions regarding perioperative practice, and they have been approved by the AORN Guidelines Advisory Board.

Perioperative practice specialists in the AORN Nursing Department serve as the lead authors of the guidelines. The lead author facilitates guideline development through collaboration with a guideline development team that includes members of the AORN Guidelines Advisory Board, including a patient advocate, and Guideline Advisory Board liaisons representing the American Association of Nurse Anesthesiology, the American College of Surgeons, the American Society of Anesthesiologists, the Association for Professionals in Infection Control and Epidemiology, the Healthcare Sterile Processing Association, the Society for Healthcare Epidemiology of America, and the Surgical Infection Society.

The AORN guideline development process is funded by AORN, Inc. Each guideline is posted for a 30-day public comment period at, where members of the public, including scientific and clinical experts, organizations, agencies, and patients can review and comment on the guideline draft. 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,use of 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.


The guidelines are informed by a comprehensive, systematic review of research and non-research evidence, appraisal of this evidence for strength and quality, and assessment of the benefits and harms of alternative care options. 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.2

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is used to prepare transparent accounts of the systematic reviews that inform each guideline.3 The PRISMA statement and checklist, first published in 2009, was used for each guideline developed or revised through December 2021. Beginning in January 2022, PRISMA 2020 is used for the development and revision of all AORN Guidelines. Changes to the content and structure of PRISMA 2020 reflect recent advancements in systematic review methodology and terminology and are intended to lead to more transparent, complete, and accurate reporting of systematic reviews, including those on which AORN Guidelines are built. Information about the search terms, PRISMA flow diagram, full search strategy, and evidence table for each guideline can be found at

Evidence Appraisal and Rating

Each guideline focuses on a specific question or topic. A clinical perioperative nurse research librarian employed by AORN conducts a systematic literature search to identify relevant literature. 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 evidence 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.


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 each guideline 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 each guideline and the assigned appraisal scores. The appraisal score is noted in brackets after each citation (eg, [IA]).

Ambulatory Supplements - Each guideline is reviewed and vetted for applicability to ambulatory surgery centers, and supplemental information is provided related to recommendations that may have additional considerations unique to 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.4 The PNDS enables the perioperative registered nurse to document perioperative care 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 are 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 or visit

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 the organization's 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


  • 1. 
  • Benze C, Spruce L, Groah L. Perioperative Nursing: Scope and Standards of Practice. Denver, CO: AORN, Inc; 2021. Accessed November 3, 2023.
  • 2. 
  • Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines; Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, eds. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Press; 2011.
  • 3. 
  • Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160.
  • 4. 
  • AORN Syntegrity Solution. AORN Syntegrity On-line Companion Guide; 2023.

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