ACORN Practice Audit Tools (PATs)

ACORN Practice Audit Tools

Running parallel to our work on developing standards and audit tools with our perioperative nursing colleagues in the Pacific, is our work with ACORN in developing practice audit tools. These are based on the ACORN standards and provide a series of tools with which to measure workplace compliance.

The first bundle is now complete – those of you who attended the ACORN Conference workshops would have noted that three of the five (perioperative attire, asepsis and infection prevention, gowning and gloving) Practice Audit Tools (PATs) were available to purchase. The final two – specimen identification, collection, handling and perioperative patient skin antisepsis were in their final stages of piloting.  The whole bundle is now available for purchase and we are making good progress with developing

Bundle 2 PATs:

  1. Documentation
  2. Surgical safety
  3. Medication safety
  4. Management of sharps in the perioperative environment
  5. Positioning the patient for surgery and Safe patient and manual handling
  6. Management of accountable items used during surgery and procedures
  7. Surgical plume and Electrosurgical equipment

We are working closely with the members of the ACORN Standards Committee to ensure all aspects are included as well as ACORN members who have volunteered to pilot the PATs. The feedback we gain from the piloting is invaluable at ‘tweaking’ the PATs so that they are practical and easy to use. We plan to have Bundle 2 completed by Christmas.

If you have not yet purchased Bundle 1, give serious consideration to doing so. The PATs provide, for the first time in Australia, a coordinated approach to auditing perioperative nursing practice. I am sure many of you already undertake some kind of auditing process which is great and the ACORN PATS can only add to that good work. Apart from providing a picture of how well (or not!) your facility is complying with ACORN Standards, when accreditation time rolls around, you will be able to demonstrate your compliance by producing the data and results. These can be very powerful evidence for surveyors as it demonstrates your compliance with national perioperative standards.

When you purchase the PATs, you receive:

  • a two-year licence (price varies depending on size of your facility)
  • 12 individual PATs (five in bundle 1 and seven in bundle 2)
  • a hard copy ‘master’ booklet for each of the 12 PATs (additional hard copies can be purchased)
  • an electronic ‘soft’ copy booklet for each of the 12 PATs – used to enter the data into excel spreadsheets and generate results in chart form
  • access to training webinars

There are two webinars which Sally and I have undertaken with ACORN where we introduce the PATs in the first webinar, entitled ‘Do you see what I see’ and in the second webinar entitled, ‘Does it all add up’ we explain how to enter the audit data collected and generate results. These are both available for viewing on the ACORN website – www.acorn.org.au. We plan to add a third webinar where we will look more at the data and how it can be used to change practice. In the Audit Tools section on the ACORN website there are a number of FAQs and also the opportunity for you to ask questions and give comment about the PATs.

Our Pacific perioperative nursing colleagues are a few steps ahead of us and have been conducting workplace audits for the past year. The generally positive audit results has given them confidence that their practice is meeting standards and in areas where the audit results have  not been so good, they have taken active steps to change practice. Anectodal evidence from Australian surgical teams who visit many of the Pacific island countries has indicated a marked improvement in standards within the perioperative environment. We can learn a great deal from the Pacific experience and ACORN is to be congratulated for not only supporting the work in the Pacific, but taking the historic step in developing PATs for Australian perioperative nurses.

NSW OTA Conference, 16 & 17 March

The theme of this year’s Conference was ‘The Future of Perioperative Nursing’, so plenty of scope for the many excellent speakers we were treated to over the two day Conference. I really enjoy this annual event, especially as I am no longer clinically active I enjoy hearing about what my colleagues are up to in their workplace, the challenges and triumphs in equal measure.

The medical companies always put on a good display in showcasing the latest and greatest in new products. What caught my eye this year? Some new, ergonomically shaped sharps trays, a number of companies with an array of disposable gowns and more companies, than I remember, demonstrating surgical plume diathermy pens.

Monique Gilbert

Monique Gilbert presented an interesting paper about the role of Medical Company Representatives (MCRs) in operating theatres. Monique identified many of the benefits when MCRs are available to come into theatres as well as some of the risks. This paper generated a lot of discussion about the nurse’s role as supervisor of visiting MCRs and the importance of educational preparation for MCRs.

I enjoyed Kathy Flanigan’s opening presentation which looked at the past and what our future perioperative nursing role will look like. Kathy is immediate past President, Perioperative Nurses Association of Queensland (PNAQ) which has more recently become ACORN Qld. She put forward her thoughts on we can do to ensure the future of perioperative nursing including:

  • maintaining our knowledge base, as knowledge is power
  • creating a dynamic team – getting the most out of your colleagues
  • making the most of workplace opportunities to improve practice
  • taking care of ourselves – remember you are not super nurse – have some fun!
  • always keeping the patient as our main focus and remembering that our daily life is work, but for the patient it could be one of the worse days of their lives – facing surgery

It was a lively and interactive start and set the tone for the Conference.

Other highlights for me:

Lilian Blair – reminding us of our responsibilities when handling S4D and S8 drugs – a good practical refresher. Key messages –  importance of a signatures register, drug book audits being done by a person from outside the OR, ensuring correct documentation – especially for incorrect entries, who can carry the keys, importance of central key safes in departments that have individual drug cupboards in each OR.

 

Lilian Blair

 

 

 

 

 

 

 

Mark Aitken –informed us about the Nurse & Midwife Support service. Funded from our AHPRA Registration fees it is a confidential, 24/7 telephone support service with trained counsellors, who can provide a vital role in supporting us when facing either personal or professional issues that may adversely affect our lives. He highlighted that many of the calls the service receive relate to stress and workplace bullying, drug and alcohol concerns either for themselves or colleagues. The service provides referrals for appropriate ongoing support. They can be contacted on 1800 667 877.

Brian Julien – an interesting presentation about Root Cause Analysis, using a case study of wrong site surgery, to review the steps involved in investigating, analysing and making recommendations when this adverse event happened to a surgical patient.  Though not a situation in which we would like to find ourselves, it was a valuable insight into the steps of an investigation and the outcome. There was much discussion from the audience about rating incidents using the SAC matrix.

Michelle Skrivanic – reminded us once again about the value of recycling and making ORs environmentally sustainable. I have heard Michelle present on this topic before, but each time, she inspires us to do more! Most recently her team at Concord Hospital have turned their attention to the tearoom and introduced reusable cups for all the staff and visitors, no plastic cutlery, a soap dispenser incorporated into the sink set up to reduce the amount of detergent used and bins to segregate waste – paper and plastics.

Penny Smalley – a frequent visitor from US and laser/plume expert unveiled the new National Laser Safety Standard (AS/NZ 4173:2018) due for release in April. It has been 14 years since the last standard, so well overdue for review, particularly with the increased use of laser both in hospital and cosmetic practice. It was clear from Penny’s presentation that many  changes will be needed to education programs and management structures to comply with the new standard. In particular for those working with Class 3b or Class 4 lasers.

Penny Smalley

 

 

 

 

 

 

Judy Smith – a thoughtful discussion on ‘Blending Care with Technology’ attempting to answer the question of whether caring can exist in a perioperative environment which use increasing amounts of technology, eg robotics. Judy discussed the impact of technology on the perioperative role – the tensions that exists each day as we grapple with ‘technology stress’ and how we can continue to be true to ourselves as nurturers, patient advocates and skilled clinicians.

Judy Smith

 

 

 

 

 

 

 

Libby Brookes – head of NSW/ACT medical negligence department in the law firm, Maurice Blackburn. She reminded us, using a number of legal cases, of the importance of keeping good medical records in the perioperative environment. She praised perioperative nurses for their skill in keeping good documentation and electronic records.

Libby Brookes

 

 

 

 

 

 

 

Overall, a great couple of days. Looking forward to our national ACORN Conference in May which will see colleagues from ASIORNA joining us for a truly international event.

Menna

Clearing the Air

This post from earlier in the year has been SO POPULAR! As a bonus to you, we are featuring it again over the Christmas and New Year break.

Surgical plume is such an important topic in healthcare settings. Are you clearing the air?

We know that the presence of surgical plume in our operating theatres is a personal risk. More importantly, our patients and colleagues may also be at risk if we are not using appropriate systems to capture and remove the surgical plume from our environment.

We have a duty of care to our patients. So, read Menna’s post and take action to reduce this work health & safety risk.

Sally and I enjoyed catching up with Penny Smalley last week during one of her regular visits to Australia. She was still on a high following an historic win in the baseball World Series for her beloved Chicago Cubs. So plenty of celebrations.

Penny, as many of you will know, is a perioperative nurse, consultant and is recognised as an expert in surgical plume and laser safety. She travels the world running workshops on these topics for medical and nursing staff and providing them with workplace support.

Menna Davies Penny Smalley laser safety smoke plume expert Sally Sutherland-Fraser healthcare consultants perioperative nursing leaders

Menna and Sally with Penny (centre) during one of her regular visits to Sydney to facilitate her laser safety workshops

During this visit she carried out audits in a number of Sydney hospitals on the use of surgical plume evacuators. She was disappointed by the results which showed there was poor compliance with the use of plume evacuators. It does beg the question, why, after all the evidence gathered over the past 20 plus years that plume contains noxious gases, chemicals, viruses and aerosolised particles that have the potential to harm us, do we as perioperative nurses continue to put ourselves at risk on a daily basis?

Did you know, for example, that 1 gram of tissue vaporised using diathermy produces plume is the equivalent of smoking 6 cigarettes in 15 minutes? (Tomita et al, 1989). Note the date of this information – 1989! The dangers of plume are not new, they have been known for decades and yet every day you can walk into an operating suite and smell the diathermy plume. wafting down the corridor. So the message about the dangers is not getting through. Why?

It cannot be through a lack of education, for not only does Penny travel the world providing education on the dangers of plume, there are plenty of nurses and doctors who regularly present papers at perioperative seminars and conferences here in Australia on surgical plume. There are ISO documents and the major perioperative nursing organisations eg ACORN, AORN, Canadian OR Nurses, Association for Perioperative Practice (UK) all of whom have standards on the management of surgical plume.

Is it a lack of leadership? Are OR managers not supporting their staff in providing the appropriate plume evacuation equipment and education? Is it that they prefer to pander to some surgeons who tell them not to waste money as there’s no clear proof demonstrating that plume is harmful?

Is it the staff who don’t speak up and insist on the use of plume evacuation equipment? Admittedly this can be difficult when faced with a surgeon who simply refuses to use the equipment. But this is where leadership comes into play.

This is a serious work health and safety issue, which has eventually been recognised by NSW Health with the publication – GL2015_002 Work Health & Safety – Controlling exposure to surgical plume. It was a long road to finally get the guideline published and Penny was instrumental in this process and with her support of the NSW Operating Theatre Association (NSW OTA) who initiated the lobbying of NSW Health, together with support from Workcover NSW and NSW Nurses & Midwives Association. How many of you know about this guideline? And how many of you use it to support your practice?

What needs to be done to bring us a plume free perioperative environment?

  • More education? Check out the references at the end of the blog for some of the latest and most compelling articles and also websites where you can access further material.
  • Greater assertiveness on the part of the nursing team in the OR in refusing to work if the surgeon does not use evacuation equipment? That would take some guts, but it would send a powerful message.
  • Completing an incident report on the days when the surgeon has refused to use evacuation equipment and your health has been put at risk. That too would send a message to management.
  • Asking the hospital’s Work Health & Safety (WH&S) team to come and undertake a safety audit – that would be pretty powerful too. WH&S should be part of your unit’s staff meeting agenda and another avenue to bring it to the attention of management.

Consider what you can do – but doing nothing is not an option. I end my presentations on management of surgical plume with a quote from former US President, John F Kennedy:

  ‘There are risks and costs to a program of action, but they are far less than the long range risks   and costs of comfortable inaction.’

Feel free to contact us if we can provide you with education resources or you would like us to run workshops for you on the management of surgical plume. We hope next time Penny is in Sydney in 2017, to organise a seminar at which she can update us on the latest in surgical plume evacuation technology and give us a timely reminder of the dangers. Penny has been instrumental in forming the International Council on Surgical Plume (www.plumecouncil.com), it’s worth checking out.

bye for now -stay safe…….

Menna

Resources

Coleman, S. (2014). Protecting yourself against surgical smoke. OR Nurse Journal. March, 41- 46. www.ORNursejournal.com

Hill, D. et al. (2012). Surgical smoke – a health hazard in the operating theatre: a study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units. Journal of Plastic Reconstructive Aesthetic Surgery 65 (7): 911- 6.

Mowbray, N. et al. (2013). Is surgical smoke harmful to theatre staff? A systematic review. Surgical Endoscopy 27, 3100 – 3107.

Rioux, M. et al. (2013). HPV positive tonsillar cancer in two laser surgeons: case reports. Journal of Otolaryngology – Head & Neck Surgery. 42-54.

Schultz, L. (2014). Analysis of surgical smoke plume components. AORN Journal 99 (2): 289-298.

Website

Nurses Advocating Smoke-Free Theatres Immediately (NASTI) http://www.becomenasti.com/

http://www.gerrygannon.com.au/surgical-plume/

Hand washing horrors – we need to do better

Not many nurses would have been surprised to read the findings of this article in the Sydney Morning Herald. Many of us have spent our careers reminding our medical colleagues to perform hand hygiene and usually copping flack for our trouble! I cringe when I reflect on my early training days (over 40 years ago) when the consultant surgeon would do his post op rounds, taking down dressings without a thought to hand hygiene being performed in between patients. Neither myself, as a lowly student, nor my more senior colleagues would consider reminding ‘Sir’ of this oversight! None of us had the courage to speak up for our patients, such was the culture and hierarchical structures of the time.  We are perhaps seeing the consequences of this culture, poor practices and lack of courage to advocate for our patients all these years later with the rise of the ‘super bugs’ and resultant mortality and morbidity. Reading the article, it was encouraging to see that hand hygiene rates are improving, but still a long way to go. All health professionals must take responsibility not only for their own hand hygiene, but in monitoring and encouraging good hand hygiene practices of others. It takes courage to speak up and remind others of correct procedures, but it can be done in a way that is respectful and should not be taken personally. I feel sure if it was a loved one suffering from an infection, we would be quick to act.

 

It is not only in hospitals that poor hand hygiene practices could be improved. I have on several occasions questioned food handlers in delis and fast food outlets who take my money with the same gloved hand they have just used to handle my food order. Last year I  reported a local café to the council for consistently not providing hand towels in the toilets used, not only by customers, but by the café staff! I gave the manager fair warning that I would be reporting him, but to no avail. Needless to say I go elsewhere for my coffee now!

 

On a lighter note, I am both heartened and amused when I see people take out small bottles of alcohol rub and perform hand hygiene in cafes and restaurants – they must be nurses I say to myself! But maybe not, I am hoping the hand hygiene message is getting through to a wider audience.

Menna

Passing the baton to the next generation

2015-09-03 07.12.15The Christmas holidays have given me the opportunity to attack the pile of perioperative nursing journals and catch up with my reading (and accrue some CPD hours!). An article that caught my eye was in the Journal of Perioperative Nursing in Australia (ACORN), (vol 29, issue 4, Summer 2016) by Seri Wilson. Whilst the content was related to Wilson’s research into retirement intentions of baby boomers (BBs) at her hospital, I found some of the statistics presented thought provoking. Wilson cites Australian Institute of Health and Welfare (2014) demographic data stating that in 2014, 38.3% (4 out of 10) of the nursing workforce were aged 50 years of age or over. Whilst these are overall nursing workforce figures, they are probably reflected in many of our perioperative environments. Wilson was making the point that the BB generation, if they haven’t done so already, will soon be leaving the profession and posed the question of whether we are doing enough to hand over to the next generation of nurses.

Being a BB myself, I am well acquainted with others of my vintage who have either retired, are about to retire or are still in the workforce. Many BBs are unable to retire due to financial reasons and there are many who just love their work. Such people were gold dust for me when I was working as a Clinical Nurse Consultant, because I knew that they would support, teach and mentor the new graduate nurses who were embarking on their perioperative careers.

The worry is – what happens when such valuable BBs finally do retire? Will we have enough perioperative nurses to take their place and will we have done enough to pass on the baton of safe patient care to them? It is a point made in Wilson’s conclusion – the need to have an appropriate handover to the next generation.2015-03-13 15.07.07

During my career as a perioperative educator, my passion has been to promote the specialty as a career path for both RNs and ENs. Long gone are the days when all student nurses (like myself) gained clinical experience in the operating theatre, where the seeds of a career in perioperative nursing were sown for me and many of my contemporaries. The reduction in the number of undergraduate nurses being exposed to perioperative nursing means that the pool of future perioperative nurses is also reduced. Many operating theatres are crying out for nursing staff, both RNs and ENs and I know, from talking to colleagues in the tertiary sector, that there are many undergraduates interested in the specialty and a clinical placement in the operating theatre. Unfortunately such interest is often not translated into action with many operating theatres being reluctant to open their doors to potentially the next generation of perioperative nurses. Why? Well, I have heard many reasons – ‘students are too much trouble’; ’we are too busy to spare the time to teach’; ‘don’t have an educator’; ‘we only do lumps and bumps’ etc, etc.

Whilst there may be legitimacy in some of these comments, I feel that operating theatres who are short of staff are really missing the opportunity to ‘grow your own’. Yes, visiting undergraduates can add to an already busy workload, but going the extra mile by allowing a them to follow a patient through surgery or providing a short rotation to the operating theatre, can pay dividends for the future. It does not matter that minor or less complex surgery is performed, the undergraduate does not care, they are fascinated by anything and everything. Whilst a CNC at Randwick Campus Operating Suite (RCOS) I assisted in facilitating a twelve month program for new graduates, the majority of whom stayed on staff following completion. They have become valuable team members and many of them are now senior staff within the RCOS.

So at the start of 2017, I have a challenge for those of you seeking staff. Consider ways in which you can ‘grow your own’.

Here are some ideas to get you started:

  • contact your local university/TAFE and offer options for exposing the undergraduates/EN students to the operating theatre – a patient follow through, a tour, an opportunity to present information about perioperative nursing at the university/TAFE
  • organise an operating theatre open day to which not only undergraduate nurses can be invited, but new graduates and nurses from other departments in the hospital. A number of current perioperative nurses started their careers in other specialties before seeing the light!
  • work with your local NSW Operating Theatre Association (NSW OTA) Zone to consider a united approach to promote the specialty

Many of you will have already tried these and maybe other strategies. Let me know what worked for you and if you haven’t tried these strategies, give it a go. Whilst I am not longer active in the clinical area (though business partner Sally is), through our business we are maintaining our passion to promote perioperative nursing as a career. We will continue to provide education to nurses who seek to enter the perioperative specialty through our Fundamentals program which was the subject of my previous blog. We are keen to run more of these courses in the coming months. So if you know of any colleagues who would benefit from the program, please let us know – we can help them take that first step.

Getting new staff into the perioperative environment is only the first step, we then have to work to educate and support them whilst they settle into their new career. So it is pleasing to see the Nursing and Midwifery Office within NSW Health launch the Transition to Perioperative Practice program. This program, to begin early 2017 and developed by experienced perioperative nurse, Deb Burrows, supported by NSW OTA, will provide new staff embarking on their perioperative careers a structured program, giving them skills and knowledge to provide safe patient care. This will overcome the need for individual hospitals to develop their own education programs and will hopefully encourage operating theatres to take on novice perioperative nurses.

We are at a critical point in perioperative nursing with the BBs moving on and what is required is a steady, ongoing supply of nurses, RNs and ENs – the new generation of perioperative nurses to take their place. The BBs have laid a solid foundation of perioperative practice, it is up to you to build the next generation and ensure the baton is passed on.

Menna Davies

Happy Perioperative Nurses Week 2016

This year, to celebrate Perioperative Nurses’ Week we’re releasing the education resources from one of our popular and recent Twilight Seminars and making it available as a GIFT for download from our website. This gift comes just in time for you to prepare for Wound Awareness Week 16th – 21st October 2016. Whether you work in the medical industry, acute care, community or aged care settings, this downloadable resource will be of interest for everyone.

Wound Assessment: What lies beneath. Bibliography and useful resources

We hope you can use it to advance your knowledge and improve the outcomes of vulnerable patients.

 

 

Lady superintendent Jane Bell, OBE.

Lady superintendent Jane Bell, OBE.

As part of the celebrations, we think it’s important to acknowledge some of the amazing nurses who have paved the way for us!

This is Jane Bell – an extraordinary woman and the first Sister in Charge in the Operating Theatres of the Royal Melbourne Hospital.

 

Looking up to Matron Grace Wilson

Looking up to Matron Grace Wilson

And here’s Matron Grace Wilson, commemorated in a poster on Sydney’s George Street. She’s doing her rounds of the 3rd Australian General Hospital on Lemnos Island in 1915.

 

There are countless more extraordinary nurses who have made a contribution to perioperative nursing care.

Who do you look up to? Let us know and we’ll post a selection of responses.

Very best wishes from Sally & Menna