AORN journal
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Successful surgery depends on collaboration and mutual trust among interdisciplinary team members. We compared teamwork quality as perceived by surgeons, anesthesia care providers, and perioperative nurses using two surveys in the same hospital. The general survey sent to the homes of the OR personnel revealed teamwork climate scores in the medium to high range. ⋯ A second single-item survey administered immediately after elective open abdominal surgical procedures also showed relatively high satisfaction with teamwork. Results of the second survey, however, showed that attending surgeons were significantly less satisfied than the members of all the other professions, and perioperative nurses were significantly more satisfied than the members of all the other professions. We conclude that general surveys about teamwork quality among members of surgical teams may not necessarily reflect teamwork quality during actual surgical procedures.
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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.