6 Guideline Updates For Your Practice

A new round of guideline updates in the soon-to-be released 2021 edition of Guidelines for Perioperative Practice reflect the latest evidence, technologies and practice needs. Guidelines Editor-In-Chief Erin Kyle, DNP, RN, CNOR, NEA-BC, suggests now is the perfect time to pull teams together to prepare for incorporating these updates into practice. 

“The COVID-19 pandemic has changed so many things about the way that we think about care delivery, and patient and healthcare worker safety, even stretching the limits of safety to care for patients during this health emergency.  It’s important to remember the important role perioperative RNs play in leading their teams toward safe practices that are grounded in the best evidence, which is found in the AORN guidelines,” she stresses.

Six Updated Guidelines

Kyle shares several important updates in six guidelines to begin planning for by updating policies, procedures and education.

1. Laser Safety
   The Guidelines for Laser Safety and Electrosurgical Safety have been split from what was the Guideline for Safe Use of Energy-Generating Devices. These guidelines were combined for publication in 2017 in an effort to eliminate duplication and provide one source of recommendations supported by current evidence for both electrosurgical and laser safety. “We made the decision to split them into their own guidelines to make the recommendations clearer and more accessible—something that the perioperative community requested,” she says.
   
   Practice updates specific to laser safety include:

• Greater emphasis on roles and responsibilities for laser safety to ensure an effective laser safety program that begins at the organizational level and requires interdisciplinary participation in which every team member has an important role.
• Recommendations for eye protection that are specific to the type of laser used.
• In responses to an increase in the use of third party laser services, new recommendations guide teams in how to include third party laser services in a laser safety program and what responsibility the organization has to verify the equipment has been properly maintained and that third party laser operators are competent and credentialed to operate the laser.

2. Electrosurgical Safety
   Practice updates include planning for electrosurgical safety for patients with implanted electronic devices, reporting malfunctions, and using standardized communication when equipment is removed from service, Kyle explains.

3. Pneumatic Tourniquet Safety
   Using limb occlusion pressure to determine the initial tourniquet pressure setting is a new recommendation.
   
   Other updates in this guideline include new recommendations for patient-specific contraindications to pneumatic tourniquets, Kyle shares. For example, “precautions specific to pediatric patients were found in the literature and informed the new recommendation to monitor pediatric patients for respiratory acidosis during procedures where pneumatic tourniquets are used.”

4. Instrument Care and Cleaning
   Practice updates in this guideline emphasize the importance of an interdisciplinary team when selecting equipment and instruments as well as establishing and implementing policies and procedures. “Surgical instruments and devices are complex, and this complexity has led to increasing complexity in manufacturer’s instructions for use for instrument processing. The manufacturer’s instructions for use are of no use to personnel if they cannot access, read, and understand them,” she says.
   
   Another important update from this guideline is using objective measurement tools to monitor the quality of water used in instrument processing, and also to use objective measurements to evaluate cleaning effectiveness, Kyle adds. “One easy way to implement water quality monitoring is to include the sterile processing department in the facility’s overall water management program.”

5. Care of the Patient Receiving Local-Only Anesthesia
   “Patients receiving local-only anesthesia are monitored by a registered nurse rather than an anesthesia professional, so it is imperative that the RN recognize adverse events such as local anesthetic systemic toxicity (LAST) and methemoglobinemia and allergic reactions,” Kyle explains.
   
   To support RNs in identifying such adverse events, this guideline update includes important recommendations highlighting the signs and symptoms that can indicate adverse reactions as well as recommendations for responding to these emergencies.

6. Specimen Management
   The guideline update includes recommendations for handling specimens collected from patients with known or suspected prion disease and handling highly infectious specimens. “This year’s pandemic gave some important perspective to the importance of the recommendations around highly infectious specimens,” Kyle shares.
   
   Another notable update she describes is the addition of recommendations for the use of vacuum-sealed containment. “It is exciting to see research that can support quality specimen containment and preservation that also serves to protect clinicians from the risks of handling hazardous preservation solutions.”
   
   With advances in diagnostics and treatment that include radioactive materials, Kyle says the evidence also supported recommendations for handling and management of sentinel lymph node specimens and radioactive seed localization specimens.