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Cite surgical unit practices and policies that prevent orthopedic complications

TIPPING POINT

Balance between a patient’s ability to fight an infection and the number and virulence of the bacteria that contaminate the wound.

Disclaimer—all people in this presentation are totally fictional. They

are not modeled after any one.

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Rachel is admitted to your facility for a total knee arthroplasty this morning. Her knee has been giving her more and more trouble causing difficulties in helping to care for her grandchildren and husband.

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CURT

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On Friday, Rachel calls Dr. Jones to say she is not feeling as well and that she thinks she is running a fever. He prescribes some oral Keflex and tells her to call him again if she is not better in 24-48 hours.

Sunday, Jeff calls Dr. Jones to say that Rachel is much worse. She is short of breath, her wound is very red, swollen and starting to drain “smelly stuff”. Dr. Jones readmits her to the hospital.

Normalization of deviance

Who?

What?

Why?

The Normalization of Deviance: What are the Perioperative Risks? McNamara, Sharon. AORN Journal. June 2011. Vol. 93, No. 6, 796-801.

Attire

Technique in opening

5 second rule—does not exist

Moving within and around a sterile field

Breaks in technique

Contribution to Normalizing Deviation

No warm-up jacket

Jewelry

May have walked too close to back table and contaminated it.

Did not hold herself, Jenny, Dr. Jones & Curt accountable

Breaks in technique

Contribution to Normalizing Deviation

Questionable practice with flipping onto back table

Dropped un-opened suture on floor

Did not hold herself, Sue, Dr. Jones & Curt accountable

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Breaks in technique

Contribution to Normalizing Deviation

Improper attire—turtle neck

Briefcase in the OR

“Cranky” attitude makes others uncomfortable correcting his aseptic technique

Break in technique

Contribution to Normalizing Deviation

Attire worn home and not changed

“Cranky” attitude makes others uncomfortable correcting his aseptic technique

Attire Environmental cleanliness Traffic control Hand hygiene Intra-operative Technique Skin Prep

Sterilization and Maintenance of Sterile Supplies

What about verification of sterility of packages? What is “event related” sterility? What about immediate use sterilization? Surgical Conscience

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“You have a very responsible position. Every set-up a doctor uses is prepared by a nurse. A good part of the doctor’s success and the patient’s well-being is in your hands. Remember this obligation. Only you can answer the question, “Did I use good surgical technique while preparing and executing this procedure?” Everyone connected with the procedure is sure you did. Have you betrayed these people and yourself?”

Willingham J. Logic of Operating Room Nursing. New York, NY: Springer Publishing Co, Inc; 1962.

References1. RP Summary: Recommended Practices for Environmental Cleaning. AORN Journal, Volume

99, Issue 5 583 – 586.

2. Implementing AORN Recommended Practices for Environmental Cleaning. Allen, George. AORN Journal, Volume 99, Issue 5, 570 – 582.

3. RP Summary: Recommended Practices for Sterile Technique. AORN Journal, Volume 98, Issue 1, 27 – 31.

4. Implementing AORN Recommended Practices for Sterile Technique. Kennedy, Lynne. AORN Journal, Volume 98, Issue 1, 14 – 26.

5. RP Summary: Recommended Practices for Hand Hygiene. AORN Journal, Volume 95, Issue 4, 508 – 509.

6. Implementing AORN Recommended Practices for Hand Hygiene. Patrick, Marcia et al. AORN Journal, Volume 95, Issue 4, 492 – 507.

7. RP Summary: Recommended Practices for Surgical Attire. AORN Journal, Volume 95, Issue 1, 141 – 142.

8. Implementing AORN Recommended Practices for Surgical Attire. Braswell, Melanie L. et al. AORN Journal, Volume 95, Issue 1, 130.

9. The Normalization of Deviance: What Are the Perioperative Risks? McNamara, Sharon A.AORN Journal, Volume 93, Issue 6, 796 – 801.

10. Common Breaks in Sterile Technique: Clinical Perspectives and Perioperative Implications. Hopper, William R. et al. AORN Journal, Volume 91, Issue 3, 350 – 367.

11. AORN Perioperative Standards and Recommended Practices 2014. AORN Inc. 2014.

12. Sherertz, et.al. Emerging Infect. Dis. 2001:7(2); 241-44.

13. Implementing AORN Recommended Practices for a Safe Environment of Care, Part II. Kennedy, Lynne. AORN Journal , Volume 100 , Issue 3 , 280 - 293