2023 Guidelines: Your Guide to Major Practice Updates

AORN has updated a record number of guidelines for a single year, and even added a new guideline—so there are eight updated topics that have significant changes to recommendations in the just published 2023 edition of the Guidelines for Perioperative Practice.

That’s why “it’s especially important this year to have the latest edition of the Guidelines,” according to Guidelines Editor-in-Chief Erin Kyle, DNP, RN, CNOR, NEA-BC. 

Kyle says teams can benefit from comparing guideline updates against their facility policies, procedures and practices to confirm changes needed to align with current evidence-based practice. For example, the updated Guideline for Processing Flexible Endoscopes reflects new practices such as sterilization when validated and using disposable endoscopes or endoscope components to address ongoing concerns of residual endoscope contamination and pathogen transmission.

She also notes it’s important to review the new Guideline for Prevention of Perioperative Pressure Injury, with evidence-based practice updates such as using a periop-relevant risk assessment to reduce harmful and costly periop pressure injuries.

“Whether you are working in inpatient or ambulatory surgical care, your team members should be collaborating to understand these important practice updates and implement all of the 2023 evidence-based practice changes that are designed to improve patient and team safety,” Kyle stresses.

Guidelines Updates At-A-Glance

To help your team begin to delve into the print edition of the 2023 Guidelines, Kyle gave Periop Today a quick look at several key updates from each guideline to help streamline your process and make sure these critical practice updates are on your radar for safe surgery.

Information Management 

• Align health information technology with patient-centered care.
• Review the latest regulatory requirements.
• Compare language in new recommendations around the distinction between the process of obtaining informed consent and documenting informed consent.

Hand Hygiene 

• Raise team awareness regarding new recommendations for nails and jewelry.
• Look at new practices for selecting and using hand hygiene sink hardware such as faucets and drains to reduce bacterial contamination from biofilms that have led to health care acquired infections.

Positioning the Patient

• Update your preoperative briefing process to include including plans and equipment for patient positioning.
• Make sure shoulder braces are no longer being used for patients in Trendelenburg to prevent brachial plexus injury.

Prevention of Perioperative Pressure Injury

• Have perioperative clinicians participate in in the organization’s overall pressure injury prevention program.
• Use a structured risk assessment tool in the perioperative environment.
• Place patients on reactive or alternating pressure support surfaces when they are identified as high-risk for pressure injury.
• Implement technology-based tools to assess patients for evidence of pressure injury.

Product Evaluation

• Leverage new recommendations for balancing clinical outcomes with cost savings in improvement initiatives.
• Operationalize information technology as an integral part of product evaluation because so many devices have technology and interoperability components.

Flexible Endoscopes

• Shift to sterilizing flexible endoscopes using the validated sterilization methods, and using disposable scopes or scopes with disposable components, such as the distal endcap and elevator mechanism on duodenoscopes.
• Evaluate human factors for endoscope processing effectiveness and look at leadership responsibility to provide and maintain a processing environment that is ergonomically sound.
• Look at new recommendations for handling at the point-of-use to decrease bioburden and biofilm formation.

Prevention of Venous Thromboembolism

• Implement nurse-initiated mechanical prophylaxis as part of an organizational protocol.
• Use standardized assessments for VTE risk and bleeding risk.

Minimally Invasive Surgery

• Employ a patient assessment to identify safety risks throughout the preoperative period.
• Determine fluid deficit thresholds for hysteroscopic procedures.
• Develop a perioperative MRI safety plan.

Implementation Tip: Use eGuidelines+

All 2023 guideline complementary implementation tools can be accessed through subscription at aornguidelines.org. Use this resource to find education materials, gap analyses, policy and procedure templates, and more to incorporate these current AORN recommended practices into your perioperative practice.