Guidelines at Work

• You use adjunct technology to verify the accuracy of soft goods counts to prevent RSI.
• You use support surfaces and materials that redistribute pressure to prevent perioperative pressure injury.
• You cover the sterile field if it won’t be used immediately.

These daily practices are habit for perioperative nurses, but they are also based in evidence. Where does this evidence come from and how does it translate into safe patient care?

Periop Today asked Guidelines Editor-in-Chief Erin Kyle, DNP, RN, CNOR, NEA-BC, to give us a refresher on how AORN guidelines are created and what the research supporting AORN practice recommendations is telling us. We also wondered what resources AORN releases with a new or updated guideline to help perioperative nurses put this research into practice—she shared these four reminders:

1. 35 evidence-based guidelines are updated on a continuous cycle to update practice guidance with the highest quality evidence.

Every guideline is updated on a five-year cycle to evaluate new research that may change an AORN recommended practice. Guideline content is written or updated by a lead author who is an AORN perioperative practice speialist with experience in research, as well as working in the clinical perioperative setting.

“Sometimes a new guideline is created in response to research and practice needs,” Kyle says. For example, this year AORN created a new guideline dedicated to preventing pressure injury because sufficient additional literature and the importance of this patient safety topic warranted making it a separate guideline.

Guidelines are released electronically throughout the year on eGuidelines+ and then published in a book that releases the following January.

2. Guideline recommendations reflect rated literature.

When it comes to developing evidence-based guidance, the quality of research matters. “AORN guideline development begins with a systematic review of the evidence, which is the foundation of evidence-based practice,” Kyle shares.

She notes that only the highest quality evidence from a synthesis of the available evidence—such as studies with no major limitations or variation between studies—that is appraised and rated according to the AORN Evidence Model is used to make a recommendation for practice . When there is little research, or limited research that is not generalizable, a conditional recommendation may be made. In some cases, there is so little or conflicting research that no recommendation can be made.

3. A team of experts reviews and approves every guideline.

All guidelines are developed in collaboration with the Guidelines Advisory Board, an interdisciplinary panel of clinical experts with eight AORN members plus liaisons from other professional organizations including:

• American Association of Nurse Anesthetists (AANA)
• American College of Surgeons (ACS)
• Association for Professionals in Infection Control and Epidemiology (APIC)
• American Society of Anesthesiologists (ASA),
• Healthcare Sterile Processing Association (HSPA)
• Society for Healthcare Epidemiology of America (SHEA), and
• Surgical Infection Society (SIS)

“This extensive review from experts in these professional organizations provides valuable insights into the impact a recommendation may have across the healthcare setting,” Kyle notes.

4. Every guideline revision includes updated guideline implementation tools.

Each time a guideline is revised, updates are also made to corresponding implementation documents in Guidelines Essentials at aorn.org/essentials to ensure new evidence-based practice recommendations are reflected in implementation tools that can be customized directly into practice, Kyle says. “These additional tools can make it much easier to implement guideline changes in practice and also help perioperative educators and leaders.”

These implementation resources for each guideline include:

• Customizable policy and procedure templates
• Gap analysis tools
• Key takeaways
• Visual how-to guidance
• Implementation road maps
• Case studies and FAQs

Every aspect of your practice is rooted in evidence that has been thoroughly researched, reviewed, and translated into practice, Kyle stresses. “The next time you prep and position your patient or use adjunct technology to augment counting, you know there is good reason for it and that you are practicing at the highest possible standard of evidence-based care to keep your patient safe.”