AORN journal
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Perioperative personnel manage autologous tissue when they care for patients undergoing procedures requiring the use of bone, soft tissue, or other autologous tissue to repair or replace defects. Use of autologous tissue can minimize the risk of rejection, disease transfer, and infection compared with the use of artificial materials. ⋯ This Back to Basics article provides strategies for managing some types of autologous tissue, including bone flaps, parathyroid tissue, skin grafts, and veins. Tissue management strategies include creating strict documentation policies, standardizing processes and communication, and implementing routine audits to assess compliance.
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The perioperative environment is fast paced and complex. Competing responsibilities, noise and distractions, and reluctance of team members to speak up when they are aware of a potential patient safety issue are all barriers to effective communication in the perioperative setting. Communication breakdowns among health care providers can lead to medical errors and patient harm. ⋯ The new AORN "Guideline for team communication" provides guidance on using standardized processes and tools to improve the quality of team communication. The key points address hand overs between phases of perioperative care; a briefing to share the surgical plan; a time out to verify the correct patient, procedure, site, and side; and a debriefing to discuss what was learned and how to improve. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.
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Meta Analysis
Systematic Review and Meta-Analysis of Cricoid Pressure Training and Education Efficacy.
We examined the evidence on the effectiveness of education and training on cricoid pressure (ie, Sellick maneuver) application. Cricoid pressure is used during rapid sequence induction and intubation to reduce the risk of pulmonary aspiration. We searched seven databases for studies on the education and training of health care personnel expected to apply cricoid pressure as a part of their regular clinical responsibilities. ⋯ The success rate for intubation increased after training according to the random effect model (95% CI = 0.157 to 0.452). Fisher's method combined probability test rejected the null hypothesis for patients (P = 4.93e-6), indicating that the application of cricoid pressure significantly improved after educational interventions. Regularly scheduled training in the application of cricoid pressure could sustain health care personnel's ability to apply effective cricoid pressure.
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We evaluated the use and cleaning of x-ray aprons and thyroid shields by surveying rural hospital system health care workers who wear x-ray aprons and thyroid shields. One hundred fifty-five of the 173 respondents were RNs (89.6%), and 94 respondents were from inpatient or outpatient surgical settings (54.3%). One hundred thirty-five respondents (78.0%) reported soiled x-ray aprons or thyroid shields, and 52 (30.1%) reported shield odors. ⋯ Standard department cleaning never occurred for 37 x-ray aprons or thyroid shields (21.4%); and 114 x-ray aprons or thyroid shields (65.9%) contacted a patient or patient item 1 to 10 times per shift. Twenty-six participants (15%) specified there were policies and procedures for cleaning x-ray aprons and thyroid shields. Use of evidence-based cleaning guidelines and manufacturer's requirements for effective spot and standard cleaning of the protective aprons and thyroid shields are warranted.