erioperative Nurse Week isNov 13 to 19, 2005. It is atime in which perioperativenurses are recognized andlauded for their professional

nursing qualities, dedication topatient care, and excellence in periop-erative practice.

Excellence generally is defined asbeing superior or exceptionally good1

at what one does. AORN promotesexcellence by supporting

the highest professional standards ofperioperative nursing practice forthe optimum care of the patientbefore, during, and after surgery.2(p9)

Optimum care implies incorporat-ing the “physiological, psychological,sociocultural, and spiritual responsesof surgical patients”3(p15) into dailypractice. Excellence in nursing care isevident in self-motivation and regula-tion, a nurse’s competence in perform-ing all required roles, and ultimately,in patient satisfaction.

Excellence in perioperative nursingpractice can be seen every day inevery setting. There are a million sto-ries in the perioperative arena. Thefollowing four scenarios provideexamples of excellence in periopera-tive nursing that occur every day in avariety of perioperative settings.

SCENARIO ONEIn a busy, nonprofit hospital with

many ORs, a small Hispanic girl hasbeen scheduled for surgery to correct agenetic deformity. The perioperativenurse first sees the patient and her par-ents in the noisy holding area. Manyother family members are in the wait-ing room. The parents look morescared than the child, and it is appar-ent that the child feels her parents’ fear.

The perioperative nurse performs abrief assessment. The nurse recog-nizes the emotional situation and usesexcellent communication skills tominimize the psychological trauma tothe family. The nurse introduces him-self to the patient and her familymembers, telling them that he is theirchild’s special nurseand that he will be withtheir child the entiretime she is in surgery.He will keep the par-ents and family mem-bers informed on theprogress of the surgeryand will come to tellthem when it is over.

The perioperativenurse tells the child hewill be with her andwill hold her hand untilshe falls asleep. Thechild will not let go ofher blanket and refusesto part with it. Thenurse allows her tohave the security of theblanket until she isasleep, then he has theblanket taken to theparents for safekeepinguntil the child is awake.

The nurse’s actionsdemonstrate caring, expertise in under-standing both the patient’s and parents’needs, and skill in helping make theprocedure go as smoothly as possible.After the procedure, the parents thankthe nurse, saying he made their child’ssurgery bearable.

SCENARIO TWOAt a small for-profit ambulatory sur-

gery center, a woman is waiting for abreast biopsy to determine if a lump iscancerous. She is quiet and withdrawn.

AORN JOURNAL • 751

Editorial NOVEMBER 2005, VOL 82, NO 5

Perioperative Nurse Week:Recognition of excellence

E D I T O R I A L

Nancy J. Girard,RN

PExcellence implies

optimum carethat incorporatesthe physiological,

psychological,sociocultural, and

spiritual responses of

surgical patientsinto daily practice.

752 • AORN JOURNAL

NOVEMBER 2005, VOL 82, NO 5 Editorial

The perioperative nurseenters as the anesthesia careprovider and surgeon areleaving. She introduces her-self and notes the woman’sbody posture and lack ofemotion. The perioperativenurse tells the woman thatshe will be with her duringthe procedure and asks ifshe has any questions. Thepatient retorts impatientlythat everyone has told hermore than she has everwanted to know aboutbreast biopsies, and she justwants it to be over. Thenurse replies that she under-stands and asks if thepatient has any requests shecan help with. The patientreplies that she would liketo see her pastor. He is therebut no one will let him in.

The nurse finds the pastorand arranges for him to seethe patient briefly before theprocedure. After a few min-utes, the nurse returns tocomplete the preparations forthe patient. She notes that thepatient is now calm but shiv-ering. She puts a warm blan-ket on her and asks if shewants some warm booties.

After the procedure, thepatient reports that the littlethings the nurse did for her,including giving her personalattention, expressing concernfor her fears and needs, andproviding for her physicalcomfort, were important.These actions meant a lot tothe patient during a period ofextreme worry. The patientlater tells the nurse that thebiopsy was negative. Thenurse demonstrated excel-

lence in all aspects of thispatient’s perioperative care.

SCENARIO THREEAn older adult patient is

scheduled for a gastroentero-scopy and colonoscopy at a

minimally invasive gastroin-testinal laboratory. The patienthas no relatives and is beingtransported from a nursinghome via ambulance. Theperioperative nurse performsa comprehensive preoperativeassessment because allrecords have not been trans-ferred with the patient. Theassessment results show awell-nourished, 82-year-oldwhite male with apparentabdominal discomfort. Hismobility is impaired becauseof arthritis. He wears glasses

for vision problems. Thenurse allows the man to wearhis glasses as long as possibleand minimizes the brightlights around him. He is cog-nitively intact and knowswhere he is and why he isthere. The nurse assures thepatient she will help himchange positions so his arthri-tis pain will be minimized.She promises to be with himto prevent any suddenmotions to his head becausethe arthritis in his neck isworrisome to him.

Knowing that olderpatients are susceptible tohypothermia, she provideshim with extra blankets. Thenurse also knows that olderadults do not metabolizemedications as fast as young-er patients do. The nurse,therefore, provides postopera-tive teaching before the pro-cedure, knowing that themedications given mightaffect the patient’s short-termmemory for several days. Theinstructions he will takehome are written in a large,dark font. A second copy ofthe instructions are placed inan envelope to be given to thetransportation person whowill deliver it to the nursinghome. The nurse continuesher excellent patient care byplacing a follow-up telephonecall to the nursing home tomake sure no unforeseenproblems have occurred.

SCENARIO FOURA perioperative nurse in an

academic setting offers a peri-operative elective everysemester and two OR bridge

After the procedure,the patient reports

that the little thingsthe nurse did, suchas giving personal

attention, expressing concern

for fears and needs,and providing

physical comfortwere very important.

AORN JOURNAL • 753

Editorial NOVEMBER 2005, VOL 82, NO 5

courses every summer in addi-tion to his regular teachingload. He has personally under-written the cost of taking twostudents to the AORNCongress for the past threeyears. He does this to promotethe importance of the periop-erative nursing specialty topatient care and to demon-strate the excellence that isrequired in the practice setting.He is a role model, mentor,and motivator. His teachingefforts during the past eightyears, have resulted in morethan 60 students becomingexcellent perioperative nursesdedicated to the profession.

MAKING A DIFFERENCEDuring Perioperative

Nurse Week, let us recognizeand applaud perioperativenurses in every setting.Whether they are staff mem-bers, managers, educators,researchers, or advancedpractice nurses, perioperativenurses are making a differ-ence in their patient’s livesand in their communities.

We must continue to pulltogether as a specialty toensure that excellence andquality care continuethrough the efforts of newnurses for many years.Congratulations to all of

you, and please recognizethe excellence that is in eachand every one of you. ❖

NANCY J. GIRARDRN, PHD, FAAN

EDITOR

NOTES1. “Excellence,” Merriam-Webster’sCollege Dictionary, 11th ed(Springfield, Mass: Merriam-Webster, Inc, 2003) 453.2. “AORN National Bylaws,” inStandards, Recommended Practices,and Guidelines (Denver: AORN,Inc, 2005) 9.3. “Perioperative patient focusedmodel,” in Standards, Recommend-ed Practices and GuidelinesDenver: AORN, Inc, 2005) 15.

Asurvey conducted by the Institute for SafeMedication Practices (ISMP) shows that many

hospital pharmacy computer systems may not bedetecting and correcting prescription errors or phar-macy order entry errors reliably, according to anAug 30, 2005, news release from the ISMP. To fieldtest when safety warnings appeared, survey partici-pants were asked to create a test patient in theirmedication order entry system used by pharmacistsand place a series of orders associated with actualerrors or hazards reported to the ISMP.

Of the 182 systems tested, only four were ableto detect all of the unsafe orders, and fewer thanhalf were able to detect orders for medications thatexceeded a safe maximum dose. Only one in fivecomputer systems was able to intercept the entryof a contraindicated medication based on thepatient’s diagnosis or condition (ie, pregnancy),and only one in four was able to detect a clinicallysignificant interaction between medications andherbal supplements. When unsafe orders weredetected, approximately nine in 10 systems allowedthe user to override serious warnings, often by sim-ply pressing a function key.

Most systems were able to provide reports ofmedication warning overrides and permitted staffmembers to build alerts for serious error-prone situations. Only half of the systems tested, howev-er, allowed the use of tall man letters to differenti-ate look-alike medication names (eg, hydrOXYzine,hydrALAzine), and only 9% allowed users to changethe font and color to highlight look-alike medica-tion name pairs.

The poor field test results may be a result offailure to update technology or software. More thanhalf (ie, 56%) of the survey participants were using asystem that was at least five years old with no recentupgrades, and 38% had been using the same systemfor eight years or more without upgrades. Certaintypes of warnings may be omitted if a medicationinformation provider’s software vendor deems themunimportant, and important alerts may not appear ifthe software content is not current or adequate.

Computer Weaknesses Compromise Medication Safety(news release, Huntingdon Valley, Pa: Institute for SafeMedication Practices, Aug 30, 2005) http://www.ismp.org/PR/PR20050830.pdf (accessed 22 Sept 2005).

Hospital Pharmacy Computer Systems May Be Unreliable