Timing is Everything: Using a Phased Toolkit Approach in Large-Scale Education.

Purpose: This article aims to share an innovative way to use virtual toolkits in large-scale education.

Description Of Program: An incredible number of educational needs exist at any time in the hospital setting. Sharing information with hundreds of nurses in different departments or campuses is a vast undertaking for the clinical nurse specialist (CNS).

Strengthening an OR Nurse Residency Program: Enhancing Education and Achieving Accreditation.

This article discusses the implementation and enhancement of an OR nurse residency program at a health care system in North Carolina. Recognizing the unique challenges and skills required in perioperative nursing, program coordinators aimed to support new nurses transitioning into the OR setting. Key enhancements included incorporating AORN's Periop 101: A Core Curriculum to provide consistent, evidence-based perioperative education and pursuing accreditation through the Commission on Collegiate Nursing Education to ensure the highest standards of excellence.

Supporting Perioperative Safety During a Disaster Through Clinical Crisis Education.

Disruptive domestic and global events can directly affect health care workers' ability to deliver safe, quality care. Health care workers should have an awareness and understanding of the disaster continuum and how their actions throughout each phase can affect the crisis response. Robust, intentional education and training for all team members is essential to uphold safe clinical environments and delivery of high-quality care during crises.

Embracing Our Differences: Advancing Diversity, Equity, and Inclusion Through Perioperative Nursing Education.

A focus on diversity, equity, and inclusion (DEI) in a health care system is critical to ensure patient safety and improve the health outcomes of all surgical patients and communities. Some patient populations continue to experience disparities that negatively affect their burden of illness, ability to access quality care, and health-related outcomes. Unconscious (or implicit) bias among clinicians can lead to unintentional discrimination against marginalized groups.

Using an Academic-Practice Partnership to Address the Perioperative Nursing Shortage.

The nursing shortage continues to affect perioperative nursing negatively. Multiple factors, including a lack of exposure to the perioperative nursing specialty during baccalaureate nursing programs, influence the number of applicants for open perioperative positions. In 2018, we formed a collaborative academic-practice partnership to address this critical gap at our facility.

Implementing a Standardized Phase-of-Care Craniotomy Education Program.

Leaders at a community hospital in the southeastern United States sought to add a craniotomy program to meet the needs of the local patient population. Perioperative and critical-care nurses required specific knowledge and skills to care for patients undergoing craniotomy procedures. The facility's education team applied adult learning theories and an innovation diffusion framework when developing an evidence-based craniotomy education program.

Strategies to Implement a Competency Assessment Verification Program.

Professional role competence is an essential element of nursing practice and an integral component of providing safe perioperative patient care. In the health care setting, verifying professional role competence and managing the associated documentation can be complex. Educators can use a variety of modalities (eg, flipped classrooms, gaming, podcasts) to present information in a manner that supports adult learning principles.

Just Culture: The Foundation of Staff Safety in the Perioperative Environment.

In today's perioperative setting, staff members are potentially exposed to a variety of safety and environmental concerns. As health care organizations implement measures to provide safe environments for perioperative team members, organizational leaders must pivot away from antiquated mindsets and responses and other hierarchical models of leadership. Foundational to creating and fostering safe environments is providing an atmosphere in which staff members, regardless of their role, are empowered to speak up for safety.

Translating Evidence Into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best Practice.

Nursing is an information-intensive profession, requiring nurses to have high information literacy and the skills to find, understand, evaluate, and use information from a multitude of sources. The advanced practice RN (APRN) is a valuable resource to support and guide nurses in this effort. The APRN's skills encompass understanding and implementing evidence-based practice, evaluating the organizational structure (eg, units, facilities, multisystem organizations) across the continuum of care, and facilitating collaboration between perioperative nurses and other interprofessional team members to sustain practice changes in the clinical setting.

Radioactive Seed Localization Program for Patients With Nonpalpable Breast Lesions.

Without early diagnosis and treatment, many lives are lost to breast cancer. Increased breast cancer awareness has facilitated research to guide health care providers toward improving patient outcomes. Research in diagnostic and treatment modalities has expanded to focus on improving the quality of life for patients with breast cancer who are living longer than expected.

Guideline Implementation: Surgical Smoke Safety.

Research conducted during the past four decades has demonstrated that surgical smoke generated from the use of energy-generating devices in surgery contains toxic and biohazardous substances that present risks to perioperative team members and patients. Despite the increase in information available, however, perioperative personnel continue to demonstrate a lack of knowledge of these hazards and lack of compliance with recommendations for evacuating smoke during surgical procedures. The new AORN "Guideline for surgical smoke safety" provides guidance on surgical smoke management.

Guideline Implementation: Patient Information Management.

Clinical documentation captured in a patient's record provides health care personnel with information that can be used to guide patient care. Data collected in electronic health records can be accessed and aggregated across the health care delivery system to enhance the safety, quality, and efficacy of care. The updated AORN "Guideline for patient information management" provides guidance to perioperative personnel on documenting and managing patient information.

Guideline Implementation: Prevention of Retained Surgical Items.

A surgical item unintentionally retained in a patient after an operative or other invasive procedure is a serious, preventable medical error with the potential to cause the patient great harm. Perioperative RNs play a key role in preventing retained surgical items (RSIs). The updated AORN "Guideline for prevention of retained surgical items" provides guidance for implementing a consistent, multidisciplinary approach to RSI prevention; accounting for surgical items; preventing retention of device fragments; reconciling count discrepancies; and using adjunct technologies to supplement manual count procedures.

Guideline Implementation: Moderate Sedation/Analgesia.

Moderate sedation/analgesia is practiced in a variety of settings and delivered by a variety of health care providers, with a goal of reducing the patient's anxiety and discomfort during diagnostic and therapeutic procedures. The updated AORN "Guideline for care of the patient receiving moderate sedation/analgesia" provides guidance on RN administration of moderate sedation/analgesia within the scope of nursing practice as defined by the state boards of nursing. The guideline addresses patient selection and assessment, staffing for the procedure, patient monitoring, medication administration, and criteria for postoperative discharge.

Pressure Ulcers: Factors Contributing to Their Development in the OR.

The prevention of health care-associated pressure ulcers (HAPUs) is an important quality measure because HAPUs are considered a never event. The literature suggests that the prevalence rate of pressure ulcers is 8.5% or higher among patients who undergo surgical procedures that last longer than three hours.

Guideline Implementation: Radiation Safety.

Because radiologic technology is used in a variety of perioperative procedures and settings, it is essential for perioperative RNs to be knowledgeable of the risks related to radiation and the ways to adequately protect patients and health care providers from unintended radiation exposure. The updated AORN "Guideline for radiation safety" provides guidance on preventing injury from ionizing radiation exposure during therapeutic, diagnostic, and interventional procedures. This article focuses on key points of the guideline to help perioperative personnel practice radiation safety.

Is Nursing Care Missed? A Comparative Study of Three North Carolina Hospitals.

Results of a survey measuring frequency, types, and reasons for missed care at three acute care hospitals in North Carolina are described. Results also are compared to those of a previous, similar study in the midwestern United States.

The bariatric patient: an overview of perioperative care.

Obesity (ie, a body mass index of ≥30 kg/m(2)) is increasing in the United States. As a result, more overweight individuals are being surgically treated for weight loss, thus making it imperative for perioperative RNs to understand obesity's effects on patients' health, its contribution to significant comorbidities (eg, diabetes, cardiovascular disease, hypertension, sleep apnea, musculoskeletal issues, stroke), the perioperative care requirements (eg, specialized instruments and equipment, positioning and lifting aids), and unique needs of these patients (eg, diet, counseling). It is vital that the perioperative nurse accurately assesses the patient undergoing bariatric surgery to provide safe and appropriate nursing interventions during the perioperative continuum of care.