Proposed AORN position statements for consideration by the House Of Delegates

AORN Journal,  Jan, 2007  

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PROPOSED POSITION STATEMENT ON PATIENT SAFETY

PREAMBLE

Perioperative patients experience vulnerabilities including diminished or absent pain defenses and inability to communicate or make personal care decisions. In addition, their interrupted defense mechanisms during invasive procedures demand that patient safety be valued as the fundamental priority even at the expense of productivity. The perioperative setting is one of the most potentially hazardous of all clinical environments. These hazards may have an adverse effect on patient outcomes including the potential for infection; hemorrhage; nerve injury; burns; wrong patient, surgery, or site; or death. Inadvertent adverse events may occur from a variety of energy sources, chemicals, biologicals, equipment, and devices, as well as numerous supplies and instruments that comprise the surgical armamentarium. Safe management of the patient's care; technical sources; and human factors (eg, communication, institutional culture, staffing patterns) serve as the vital components to create a safe, team-based perioperative environment. Perioperative nurses use the Perioperative Nursing Data Set (PNDS) to describe patient care interventions and actions taken to protect the patient and promote positive patient outcomes and the resources required to accomplish the expected outcomes. (1) The safety of patients undergoing operative or other invasive procedures is the primary responsibility of the perioperative registered nurse.

POSITION STATEMENT

AORN believes that it is the right of every patient to receive the highest quality of care in all surgical/procedural settings and that all health care providers must collaboratively strive to create an environment of patient safety. Every patient scheduled for a surgical or invasive procedure deserves to have a registered nurse throughout the continuum of perioperative care, including an registered nurse in the role of circulator. (2,3) The perioperative registered nurse forms a professional bond with the patient through patient advocacy. (4) The patient-nurse bond is further strengthened through nursing interventions that promote optimal surgical and procedural outcomes. The patient's physical and emotional needs are entrusted to the perioperative registered nurse by the patient and his or her family members, who also believe that the care provided will be safely and effectively delivered by the entire health care team.

AORN is committed to promoting patient safety by advancing the profession through scholarly inquiry to identify, verify, and expand the body of perioperative nursing knowledge. AORN accepts the responsibility and accountability as a leader in patient safety dedicated to reducing error, educating health care providers and patients about safe practices, and creating innovative and collaborative strategies to strengthen the culture of safety.

Editor's Note: The following proposed AORN position statements were approved by the Board of Directors in November 2006 and will be presented to the 2007 House of Delegates in Orlando, Fla, for ratification. For the order and time of presentation, see the Forum and House Agenda on pages 88-90.

REFERENCES

(1.) Beyea S, ed. Perioperative Nursing Data Set. 2nd ed. Denver: AORN, Inc; 2002:vii.

(2.) Statement on mandate for the registered professional nurse in the perioperative practice setting. In: Standards, Recommended Practices, and Guidelines. Denver: AORN, Inc; 2006:362.

(3.) AORN. Position statement on one perioperative registered nurse circulator dedicated to every patient undergoing a surgical or other invasive procedure. Available at: http://www.aom.org/about /positions/pdf/POS-Nurse%20Circulator.pdf. Accessed June 21, 2006.

(4.) Standards of perioperative professional practice. In: Standards, Recommended Practices, and Guidelines. Denver: AORN, Inc; 2006:401-404.

PROPOSED POSITION STATEMENT ON ON PATIENTS AND HEALTH CARE WORKERS WITH BLOODBORNE DISEASES

PREAMBLE

Bloodborne infections, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV), pose an occupational risk to perioperative nurses as well as the entire surgical team. Although the exact prevalence of these diseases in the general population is not known, a study done in a general surgical practice found 38% of the surgical cases studied were positive for the bloodborne pathogens HIV (26%), hepatitis B (4%), and hepatitis C (17%). (1) The occupational risk of transmission depends on the route of exposure and concentration of the infectious agent. The majority of occupational transmissions to health care workers have resulted from hollow-bore needle sticks and cuts from contaminated sharp items. After sustaining a needle stick by a needle contaminated with HIV, 0.3% of health care workers contracted the virus. The next highest incidence of transmission to health care workers occurred via mucous membrane splashes. After a mucous membrane splash, less than or equal to 0.1% of persons exposed contracted HIV. (2) Hepatitis viruses have a higher concentration in blood. After sustaining a needle stick by a hollow-bore needle used on a patient with HBV and with no postexposure prophylaxis, 5% to 35% of health care workers who are unprotected by the hepatitis B vaccine series contracted the disease. This is dependent on hepatitis B e antigen (HBeAg) status and viral titer of the source. (3) The risk of developing HCV after percutaneous exposure is 1.8%. (2) Cuts and needle stick bloodborne exposures occur in 15% of interventions. The patterns of exposure risk for personnel in the operating room include: