Joy Jensen - ACORN Qld - ACORN Board Update

ACORN UPDATE: IIR OR Managers

Conference

Joy Jensen

Qld Director & Honorary Treasurer, Australian College of Opera<ng Room Nurses

ACORN

Periopera:ve Nurses Associa:on of Queensland

NSW/ ACT Opera:ng Room Nurses Associa:on

Victorian Periopera:ve Nurses Group

Tasmanian Opera:ng Room Nurses

South Australian Periopera:ve

Nurses Associa:on

Opera:ng Room Nurses Associa:on of WA

Northern Territory Periopera:ve Nurses

Interna:onal Federa:on of Periopera:ve Nurses (IFPN) Asian Periopera:ve Nurses Associa:on (ASIORNA)

Represen:ng 3,750 periopera:ve nurses na:onally

Vision and Purpose

VISION

Leading, promo<ng and advoca<ng on behalf of our local state-‐based associa<ons, members, and the periopera<ve nursing profession

PURPOSE

Serving pa<ent, community and the periopera<ve profession to deliver posi<ve outcomes

ANNOUNCEMENTS AND ACHIEVEMENTS

Congratula:ons, Ruth Melville President, Interna<onal Federa<on of

Periopera<ve Nurses

Welcome, Wendy Rowland Execu<ve Officer, Australian College of Opera<ng

Room Nurses

ACORN Board & State Presidents Strategic Planning Day 2015

Periopera:ve Nurses Week

•  Lets reflect on the spirit of the ANZACs

•  Create and display a poster during Periopera<ve Nurses Week

•  Take a photo and forward it to ACORN by 30th October 2015

ACORN Conference Hobart 25th – 28th May 2016

Achievements 2015

•  MOU with Elsevier Publishing

•  Founda<on member Interna<onal Council on Surgical Plume

•  Four successful ACORN Standards webinars

•  MOU with University of Tasmania

Achievements 2015 con$nued

•  MOU with RACS/ANZCA for SAST (Safer Aust Surgical Team) project

•  Stakeholder, ACSQHC na<onal standards review

•  Finalised recommenda<ons for periopera<ve labelling of medicines & fluids

•  Inaugural members survey

•  Inaugural Board/Presidents strategic planning day

ACORN Board

Censor Panel

Finance & Governance

Standards Standards Editor Standards Faculty

Journal Chair, Editorial Board Editorial Board

Membership & Marke:ng

Conference Conference Organiser

Educa:on & Research

Educa:on Officer

Execu:ve Officer

Administra:ve Officer

State Presidents

Shared Governance Framework

ACORN Commi\ees

•  Standards Commièe

•  Journal Editorial Board

•  Conference Commièe

•  Membership & Marke<ng Commièe

•  Educa<on & Research Commièe

ACORN Standards Review Process

Team Formed

• Editor

• Team leaders

• Experts

• Stakeholders

Literature Reviewed

• Published

• Unpublished

• Legisla<on

• AS/NZS

• NSQHS

Standard Revised

• Review team

• Stakeholders

• Members

• Editor

Standard Approved

• Standards Commièe

• ACORN Board

3 monthly release cycle

New Secure Web Interface

ACORN Standards coming soon!

Currently under review

•  Asep<c technique

•  Scrubbing, gowning and gloving

•  Anaesthe<c nurse role

•  Loan equipment

•  Organ procurement (new)

ACORN Standards Updated since May 2014:

•  Infec<on Preven<on

•  Periopera<ve Aere

•  Fa<gue in the Periopera<ve Environment

•  Environmentally Sustainable Periopera<ve Prac<ces

•  Electrosurgical Equipment

•  Management of Sharps in the Periopera<ve Environment

ACORN Standards

Updated since May 2014 but not being discussed today:

•  Periopera<ve Nurse Surgeon Assistant

•  Planning and Design of the Periopera<ve Environment

Infec:on Preven:on Overview OLD – first complied in 1989 and revised 2010 – 26 references cited: 8 Standard Statements

NEW Standard: revised 2014 – 66 references cited and addi<onal resources in appendix’s (A, B, C, D)

12 Standard Statements aligned to the Na<onal Health & Safety Health Service Standards (no’s 1, 2, & 3)

Purpose:-‐ “provides guidance and a means of evalua<ng your own hospital’s prac<ce associated with infec<on preven<on. The preven<on of infec<ons in both our pa<ents and periopera<ve staff are the over-‐riding aims”.

• SS1 – Governance requirements

• SS2 -‐ Includes pa<ent and consumer engagement

•  Prohibi<ng of foodstuff or food items in restricted, semi-‐restricted and restricted zones (SS4)

•  Sets out requirements for staff immunisa<on (SS3)

•  Number of staff per OT (SS4)

•  SS 9 – ANTT (Asep<c non-‐touch technique)

•  SS 11 – an<microbial stewardship program

•  SS12 – Procedures & Polices to ensure instruments are appropriately cleaned, disinfected and or sterilised in accordance with established standards

According to the ACORN Standard: Infec:on Preven:on – The revised standard now has 12 standards instead of 8 and aligns with the Na:onal Safety and Quality Health Service Standards – true or false?

1 2

0%0%

1.  True

2.  False

Infec:on Preven:on Q1

Infec:on Preven:on:

True:

• Addi<ons to the standard include consumer engagement and simplifica<on of standard and transmission based precau<ons. Other addi<ons include preven<on requirements in restricted, semi-‐restricted and non-‐restricted zones with reference to prohibi<ng entry of items and foodstuff; staff immunisa<on requirements; numbers of staff-‐occupancy in a theatre; and <me limita<ons on reprocessing of reusable medical devices in light of new research on both dry and wet biofilm forma<on.

According to the ACORN Standard: Infec:on Preven:on – is hand hygiene only required before and afer every episode of pa:ent contact? True or False?

1 2

0%0%

1.  True

2.  False

Infec:on Preven:on: Q2

Infec:on Preven:on

False:

See Statement 7.5 – In addi<on to the 5 moments of Hand Hygiene, hand hygiene should also be performed in a range of non-‐clinical situa<ons, including upon arrival at the health care facility, before and aner using the bathroom, before and aner ea<ng, before leaving the health care facility, before pueng gloves on and aner removing them.

Periopera:ve Agre

OLD – First compiled 1983 and revised 2009: 26 references cited. 9 Standards Statements.

NEW: Revised 2014 with 106 cited references: 11 Standard Statements

New informa<on includes what cons<tutes periopera<ve aere and guidance on change rooms and locker spaces. No briefcases, handbags, backpacks or laptops should be brought into restricted areas (SS1).

Policy for use of cover gowns outside of opera<ng room (SS1)

Changes to home laundering of periopera<ve aere in light of new research and data (SS3)

•  The scalp, sideburns, facial hair, ear and the nape of the next should be completely covered by a single head cover to minimise microbial dispersal (SS2)

•  SS2 -‐ “Ensure that headwear worn for religious or cultural reasons is cleaned daily and completely covered by a balaclava-‐type covering”.

•  SS2 -‐ outlines a detailed process for care of personal, woven-‐fabric theatre hats or scrub suits

•  SS5 – occupa<onal footwear criteria plus note on overshoe covers

•  SS6 – audi<ng the wearing of masks within the restricted areas of the periopera<ve aere

According to the revised Periopera:ve Agre Standards -‐ Is the skin of staff known to be a key dispersal source of bacteria into the air?

1 2

0%0%

1.  True

2.  False

Periopera:ve Agre: Q1

Periopera:ve Agre

True:

•  Human skin is colonised with bacteria that are con<nuously shed and disseminated into the air. Squames or flakes of skin can carry up to five bacteria each.

According to the revised Periopera:ve Agre Standards -‐ Can backpacks, brief cases, handbags and laptops be brought into a restricted opera:ng room zone?

1 2

0%0%

1.  True

2.  False


Periopera:ve Agre

False:

•  No, healthcare facili<es should provide healthcare workers with adequate storage space to avoid personal belongings being brought into restricted areas, where they are likely to contain contaminants such as hair, dust and micro-‐organisms.

According to the revised Periopera:ve Agre Standards – Can woven fabric “cloth” hats be worn by opera:ng room nurses?

1 2

0%0%

1.  True

2.  False


Periopera:ve Agre

True:

• In Standard Statement 2 of the Periopera<ve Aere Standard it states that 2.10 If woven fabric hats are permièd, local policies regarding their use and maintenance is required to ensure the Australia Standard for healthcare tex<les, surgical aere, labelling and laundering are met. Statement 2.13 goes on to outline the requirements in detail.

Electrosurgical Equipment

OLD – first compiled in 1998 and revised in 2009

• 4 Standard Statements: related to risks, educa<on, rou<ne checking and documenta<on

• 4 references only cited

NEW – revised in 2014 with greater focus on pa<ent safety and technological trends – 29 references cited!

• 4 Standard Statements: change of order and educa<on program info expanded

• Detailed risk management criteria to reduce risk and promote pa<ent safety, esp in rela<on to implantable electronic devices

• Documenta<on of detachable parts of ESU devices to be counted

A pa:ent’s pacemaker can interfere with electro-‐surgical units/devices? True or False?

1 2

0%0%

1.  True

2.  False

Electrosurgical Equipment: Q1


True:

•  Electrosurgical units have been shown as stated in ACORN Standard: Electrical Equipment to be associated with pa<ent injury, the most common being burns, however an ESU may cause fires, electrical shock and explosions.

Detachable parts of electrosurgical devices on the opera:ve field do not need to be counted and documented as part of the management of accountable items? True or False?

1 2

0%0%

1.  True

2.  False

Electrosurgical Equipment: Q2


False:

•  Standard Statement 4 of the ACORN Standard: Electrical Equipment recommends that all detachable parts of the ESU devices are considered as a risk of being retained and should be counted and documented in the periopera<ve pa<ent record.

Management of Sharps in the Periopera:ve Environment

OLD – first compiled in 2007

• 4 Standard Statements included

• 17 References cited

• Statements focus around -‐ Neutral zone; appropriate PPE, Safe disposal and Sharps preven<on educa<on programs

• Stated that clinical research in this area was poor

NEW -‐ updated in 2014 to reflect WHO recommenda<ons

• 4 Standard Statements – similar but a lot more detail – 44 references cited

• Greater emphasis on both HCF & individual risk management approaches

• Minimising handling of sharps, avoiding direct hand to hand passing of sharps, keeping visual contact and isola<ng sharps on the instrument trolley

• Detailed informa<on on requirements for removal of scalpel blades and sharps on instrument sets

The most frequently implicated device in sharps injuries iden:fied by the Exposure Preven:on Informa:on Network was suture needles?

1 2

0%0%

1.  True

2.  False

Management of Sharps in the Periopera:ve Environment: Q1

Management of Sharps

False:

•  ACORN Standard: Management of Sharps in the Periopera<ve Environment states that disposable syringes represent 37.5%, followed by suture needles 19% and scalpels 7%.

Double gloving, blunt suture needles and the use of hands-‐free sharps transfer methods assist in reducing injuries to periopera:ve nurses?

1 2

0%0%

1.  True

2.  False

Management of Sharps in the Periopera:ve Environment: Q2

Management of Sharps

True:

• Health Care workers shall take precau<ons to prevent sharp related injuries by minimising handling of sharps, avoiding direct hand to hand passing of sharps, avoiding holding sharps in the neutral zone, keeping visual contact with the sharp device and isolate sharps within the restricted area on the instrument table.

Fa:gue in the Periopera:ve Environment •  NEW – Guideline 2014 – 3 Guidance Statements. The guideline has been

developed to provide a framework to prevent, iden<fy and manage fa<gue within the periopera<ve seeng in order to support a safe work environment.

•  GS1 -‐ Health care facili<es shall promote a culture of safety by having wrièn policies, procedures and guidelines rela<ng to fa<gue management for the delivery of safe and effec<ve nursing care.

•  GS2 -‐ To enable clinicians to func<on safely and efficiently within their work roles, the manager at the unit level should recognise the poten<al of fa<gue when considering staffing alloca<ons, rostering and workload u<lisa<on

•  GS3 -‐ The Periopera<ve nurse shall be aware of the pa<ent and individual safety risks in rela<on to fa<gue.

Fa:gue in the Periopera:ve Environment: Do long work hours, heavy workloads, staff shortages contribute to adverse events and impact on pa:ent safety?

1 2

0%0%

1.  True

2.  False

Fa:gue in the Periopera:ve Environment: Q1

Fa:gue

True: • Fa<gue, in broad terms, is a state of mental and physical exhaus<on. It can impact on the inability or unwillingness to con<nue effec<ve and safe performance of a physical or mental task. Landmark research has iden<fied that fa<gue can affect a worker’s performance to a level equivalent to that seen with alcohol intoxica<on. Recent research on nursing workloads demonstrates that increased levels of fa<gue impact on the error rate by a factor of 2–3 <mes when nurses work 12.5 hours or longer. The literature also points to several factors which have been shown to increase fa<gue amongst periopera<ve nursing staff. These have encompassed, and are not limited to, physical, emo<onal and cogni<ve demands, prolonged standing, limited breaks, work rostering, call backs, lead wearing and manual handling (taken from background of Guideline).

Fa:gue in the Periopera:ve environment: True or False, is it okay for an opera:ng room nurse to arrive at work with a hangover or in an unfit state?

1 2

0%0%

1.  True

2.  False


Fa:gue

False:

• According to the guideline (3.1) staff are to arrive at work in a fit state to conduct du<es safely; that is, the periopera<ve nurse shall not be affected by illness, drugs, sleep depriva<on, stress, alcohol, fa<gue or emo<on which may impair ra<onal cogni<ve decision making

Do you believe you have a responsibility to report a colleague that appears fa:gued?

1 2

0%0%

1.  True

2.  False


Fa:gue

True:

• Health organisa<ons and individual health professionals have a combined responsibility, obliga<on and ethical responsibility to ensure that staff arrive to work well rested and undertake their work competently and within a safe manner (background from guideline).

Environmentally Sustainable Periopera:ve Prac:ces

New – Guideline released in 2014: 33 References cited & Addi<onal resources page; Appendix has examples of Waste Disposal Poster & Flyer; 6 Guidance Statements

GS1:All periopera<ve nurses should be aware of state and federal legisla<on or regula<ons, and local health care facility policies, on waste regula<on, waste classifica<on, and waste segrega<on prac<ces

GS2: A regulated medical waste segrega<on program should be opera<onalised in the opera<ng suite.

GS3: Periopera<ve nurses should develop a performance improvement program that encourages a sustained environmental program to support and manage waste materials in the periopera<ve environment.

Environmentally Sustainable Periopera:ve Prac:ces cont’d

GS4: Health care facili<es should provide educa<on to all workers on waste minimisa<on, promo<ng a culture that reduces, reuses and recycles waste

GS5: Periopera<ve nurses should be knowledgeable about the impact of purchasing on resource consump<on, waste produc<on, and burden to the environment.

GS6: Periopera<ve nurses should ac<vely promote and par<cipate in natural resource conserva<on strategies, including water, electricity and natural gas measures, that are cost effec<ve, conserve natural resources, are eco-‐friendly and are sustainable

In rela:on to the new ACORN Guideline on Environmentally Sustainable Periopera:ve Prac:ces -‐ should waste minimisa:on educa:on include the benefits of resource conserva:on, raising awareness of environmental issues and foster a culture of responsibility to periopera:ve nurses?

1 2

0%0%

1.  True

2.  False

Environmentally Sustainable Periopera:ve Prac:ces: Q1

Environmentally Sustainable

True:

•  Statement 4 of the ACORN Guideline on Environmentally Sustainable Periopera<ve recommends periopera<ve nurses are provided educa<on on waste minimisa<on, promo<ng a culture that reduces, reuses and recycles waste.

Can all sec:ons of the ACORN Guideline on Environmentally Sustainable Periopera:ve prac:ces be implemented?

1 2

0%0%

1.  True

2.  False

Environmentally Sustainable Periopera:ve Prac:ces: Q2

Environmentally Sustainable

False:

•  It needs to be acknowledged that not all sec<ons of this guideline will be serviceable by all health care facili<es due to specific state and territory regula<ons and geographical varia<ons from rural to urban.

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Joy Jensen - ACORN Qld - ACORN Board Update