New protocols, new equipment, new research — it can be challenging to keep up with the rapidly changing dynamics of a perioperative nursing job. Despite your best effort to stay on top of it all, the sheer volume of changes in healthcare and surgical center careers can make new, trending, or even quirky topics relevant to your profession easy to miss.
Here are a few recent developments that may have skirted your radar:
Who Wears It Better?
It’s called the curious case of caps — a clash between professional healthcare associations that have made head gear, of all things, a hot topic in surgical settings.
A mini feud erupted in August 2016 when the American College of Surgeons (ACS) replied to a guideline update on safe surgical attire issued by the American Association of periOperative Registered Nurses (AORN). The nursing association’s guidelines support full covering of “head, hair, ears and facial hair” for professionals in semi-restricted and restricted operating room areas and favor use of the so-called bouffant cap, a fashion-defying but often-used head covering, closely resembling a shower cap. Nope, said the surgeon group in publishing its own guidelines (the first time the organization addressed dress code in the OR). According to the ACS, the traditional surgeon’s cap, also called a skullcap, represents the better route because it symbolizes the surgical profession and preserves “professionalism, common sense, decorum, and the available evidence.”
Weighing in heavily on team bouffant, AORN fired back, criticizing the ACS for prioritizing symbolism over patient safety and promoting etiquette over evidence-based practice. Surgeons, in the meantime, decried bouffant caps as hot, uncomfortable, and never before necessary, as reported by The Boston Globe.
The federal government, via the Centers for Medicare & Medicaid Services, will rely on the AORN guidelines, the Globe reported; but the last say in the great hat debate could come from the Joint Commission, which says it will analyze both sets of guidelines before taking a side.
Smoking Ban
Even if you’ve never smoked, or you quit the habit, a perioperative nursing job could still put you at risk for respiratory illness from surgical equipment.
The hazards of surgical smoke plume and aerosols —byproducts of the use of lasers, electrocautery and ultrasound devices, and other energy-based equipment in the operating room — have been known for more than a decade. While the use of electrosurgical devices has risen exponentially with a surge in minimally invasive procedures, progress toward reducing or eliminating the risk of surgical smoke has remained slow.
The Occupational Safety and Health Administration estimates that half a million U.S. surgical center workers are exposed each year to smoke plumes carrying carbon monoxide, polyaromatic hydrocarbons, and other toxic gases. AORN describes the risk to perioperative nurses and other healthcare professionals in the operating room in a striking way: Exposure to surgical plume, it says, amounts to the equivalent of smoking 27 to 30 unfiltered cigarettes each day. According to the association, perioperative nurses “experience twice the incidence of many respiratory problems as compared to the general population.”
A growing market for smoke evacuation systems — high-flow vacuum sources that capture smoke and gases centrally or at the surgical site — show promise for achieving smokeless ORs. A 2017 market analysis, however, cautions that a current emphasis on cost containment could contribute to lackluster adoption of the systems by healthcare facilities. For its part, AORN has partnered with medical technology giant Medtronics to raise awareness of the dangers of surgical smoke to both healthcare professionals and patients through its Go Clear campaign. The newly launched program provides interprofessional education activities, testing, gap analysis, and monitoring for participating hospitals, ambulatory surgery centers and office-based practices, culminating in recognition with a Go Clear award.
Musical Interlude
Reggae icon Bob Marley once said, “One good thing about music, when it hits you, you feel no pain.”
He might have been onto something, or so researchers from University Hospitals Seidman Cancer Center in Cleveland set out to demonstrate. Two music therapists and a nurse anesthetist tested the value of music therapy in reducing anxiety among women undergoing biopsy for breast cancer. The results of their two-year, randomized study, reported in the September 2016 issue of AORN Journal, showed patients who listened to either live music performed bedside by a music therapist or recorded music shortly before their procedures reported significantly less anxiety than patients who didn’t listen to tunes.
While acknowledging that additional studies are needed, the study’s authors think patients can benefit in anxiety reduction and pain management when surgical centers add music therapists to their rosters.
Fragility Test
There’s good news for the senior set undergoing elective surgery: A new study found that preoperative screening of elderly patients for frailty reduces postoperative mortality.
Researchers at the Veterans Affairs Pittsburg Healthcare System in Pennsylvania implemented a Frailty Screening Initiative based on a 14-point questionnaire performed at intake with elderly patients undergoing elective noncardiac procedures. Patients identified as frail received tailored surgical planning and perioperative care reviewed by surgical, anesthesia, critical care, and palliative care practitioners.
The study’s findings, published in the Nov. 30 edition of JAMA Surgery, showed participating patients’ overall 30-day mortality rate fell from 1.6% to 0.7 % after frailty screening. While mortality decreased among robust patients (from 1.2% to 0.3%), those identified as frail showed the most significant improvement in mortality, with rates falling from 12.2% to just 3.8%. What’s more, at 180 and 365 days postop, mortality rates among patients determined preoperatively to be frail fell from 23.9% to 7.7% and 34.5% to 11.7%, respectively.
The study’s authors believe implementation of preoperative frailty screening could improve outcomes for elderly patients across surgical settings.
Game On
And you thought virtual reality gaming was just the latest brouhaha for all the cool kids. From training tools to treatment protocols, new realities — virtual, augmented, and mixed — aren’t just popping in all the right places in healthcare, they’re set to explode.
Nursing schools are moving past patient simulators to incorporate wearable technology, including VR headgear and sensory gloves, into game-based learning for students. Boise (Idaho) State University’s nursing program, for example, won a national award in 2016 when it partnered with game developers to create a VR platform that allows students to address complex patient situations in a hands-on, real-but-not-really-real way. In a 3D environment, students can “touch” objects and patients and practice procedures at their own pace.
VR equipment is also making its way into on-the-job training for perioperative nurses. As a fix for expensive, time-consuming training for nurses new to surgical settings (double scrubbing with experienced colleagues, for example), a Canadian hospital pioneered the integration of VR to help scrub nurses learn to pass instruments and operate equipment before they set foot in the operating room. VR training, the hospital says, significantly cuts training time and costs for nurse and surgical residents.
Look for VR use with surgical patients, too. A surgeon in Mexico City is testing use of VR as a high-tech distraction that replaces sedation for patients undergoing procedures for which a local anesthetic might suffice.
Get Outta My Operating Room?
Medical device representatives have found a place on the sidelines in many ORs, where they help surgical teams with technical aspects of advanced equipment. But should they be there?
Particularly in neurosurgery and orthopedics, where use of high-tech equipment has rapidly expanded, industry reps’ presence in the operating room has become commonplace. Device reps do not scrub in, and state laws typically bar them from direct contact with patients; but they’re not medical professionals by any stretch. Yes, they’re experts in the equipment they represent, and yes, they offer valuable technical and troubleshooting expertise during procedures. Still, they’re salespeople employed by equipment manufacturers, not hospitals.
New scrutiny of the role of device reps, some of it resulting from lawsuits and some from provisions of the Affordable Care Act, is causing hospitals to take a second look at their necessity in the operating room. While instances of reps overstepping their bounds have reportedly occurred, a chief concern among hospital administrators revolves around informed consent. Most patients are unaware that a device rep may be present during their surgical procedure.
At Eisenhower Medical Center, we’re committed to helping perioperative nurses stay up-to-date with the information they need to enjoy long, successful careers. We offer education programs, including access to free or low-cost continuing education activities, and Nursing Grand Rounds, among other training opportunities. Apply with us today!
Originally posted on 16/2/2017