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Keeping Up with the Evidence

Publish Date: January 13, 2021

Guidelines Print ImageSafely managing surgical volume through the COVID-19 pandemic has been an important goal for hospitals to serve patients and maintain financial health.

Each of AORN’s 34 practice guidelines are reviewed on a five-year cycle to update changes in practice with new evidence. However, we know evidence is always emerging that influences our perioperative practice. That’s why AORN’s nursing practice specialists keep a close eye on newly published research that requires on off-cycle practice change, notes Guidelines Editor-in-Chief Erin Kyle, DNP, RN, CNOR, NEA-BC.

For example, in November 2020 the Guideline for Positioning the Patient received an off-cycle update when literature was identified that supported modifying the wording of the recommendation NOT to use shoulder braces for positioning patients in the Trendelenburg position.

Instead of saying “do not use shoulder braces, if possible” the guidelines now states: “do not use shoulder braces.”

“We determined that the potential threat to patient safety necessitated an immediate change in the guideline wording,” Kyle explains. This change was made in November 2020 to the online version of the guideline in eGuidelines+ and is in the 2021 print edition that is now available for purchase.

Adapting to Change

Off-cycle changes to the guidelines have also emerged throughout 2020 as the COVID-19 pandemic has created scenarios where clinicians in every setting have needed quick and convenient access to evidence-based practice recommendations to ensure that their practice is safe for themselves and their patients.

We, as a health care community, and a society, have learned so much about virus transmission. The recommendations from CDC and world leaders in public health changed throughout the pandemic experience, proving that “real-time access to evidence-based practice recommendations have never been more important than they are today,” Kyle stresses.

AORN also developed tools to help perioperative RNs, teams, and health care organizations make the best decisions to respond to the challenges of the pandemic. These resources can be found in the COVID-19 tool kit on the AORN website, and in the eBook Perioperative Care of the COVID-19 Patient in eGuidelines+. 

Making the Guidelines Easier to Use

Knowing what changes are made to the guidelines is a critically important way all perioperative professionals can keep up with new evidence that impacts their practice.

To help readers find these updated guidelines, there is a list of revised guidelines right on the front cover of the 2021 edition and these updated guidelines are also highlighted in the table of contents, including:

  • Electrosurgical Safety
  • Instrument Cleaning
  • Laser Safety
  • Local Anesthesia
  • Pneumatic Tourniquet
  • Specimen Management

For planning for next year, the revised guidelines that are scheduled for next year are listed on the back cover. “We added this in an attempt to help our readers know what is coming next year.”

These guideline revisions, which will be on Guidelines+ in 2021 and in the 2022 print edition, include:

  • Complementary Care Interventions
  • Information Management
  • Moderate Sedation
  • Patient Skin Antisepsis
  • Radiation Safety
  • Retained Surgical Items
  • Surgical Smoke Safety

Appraising the Evidence

To find the evidence in any guideline, the 2021 print book retains its easy-to navigate format that was first seen in 2020. “We gathered reader feedback for the print book and discovered that it was not easy for them to identify which guidelines had been revised for the new version.”

Within a guideline, each article or study cited is assigned a consensus appraisal score that is agreed upon by reviewers. After the evidence is individually appraised, the evidence supporting each recommendation is rated as high-, moderate-, or low-quality using the AORN Evidence Rating Model. The strength of the recommendation is rated based on the evidence rating, a benefit-harm assessment, and consideration of resource use. Then the recommendations in each guideline are given one of the following color-coded ratings:

  • [Regulatory Requirement]
  • [Recommendation]
  • [Conditional Recommendation]
  • [No Recommendation]

Evidence ratings were added to the AORN Guidelines in 2012 and the evidence model has been refined since then with updates in 2014, 2015, and 2019.

“Today, we use evidence appraisal methods that are consistent with the National Academies of Medicine’s Clinical Practice Guidelines We Can Trust,” Kyle explains. “This is important because the foundational elements of trustworthy guidelines are what the AORN Guidelines are built upon.” 

AORN Guidelines are featured in the ECRI Guidelines Trust, which only accepts guidelines for inclusion when they meet predetermined criteria and are scored using the TRUST scorecard, Kyle adds. “This can give perioperative professionals confidence that what is recommended for safe surgical practice in AORN guidelines represents a strict and thorough process with every practice based in evidence to ensure safety in all aspects of perioperative care.”

Learn about AORN’s Evidence Rating.

Read about 6 of the latest guideline updates.

Order your of Guidelines for Perioperative Practice.

FREE Resources for Members

Quickly and easily learn and implement guidelines changes using the members-only Guideline Essentials. Plus, sign up to watch the recording of an AORN Webinar for each updated guideline (free for members).

Laser Safety
Guideline Essentials

Pneumatic Tourniquets
Guideline Essentials

Electrosurgical Safety
Guideline Essentials

Instrument Cleaning
Guideline Essentials

Local Anesthesia
Guideline Essentials

Specimen Management
Guideline Essentials

Learn more on 2021 Guidelines: 6 Top Practice Updates in The Periop Life blog.