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Standards of Administrative Nursing Practice: Operating Room
Standards of Administrative Nursing Practice: Operating Room Rationale. As a professional association, the Association of Operating Room Nurses, Inc, believes measures must be provided to judge the competency of its membership and to evaluate the quality of services rendered to patients who experience surgical intervention. Evidence that operating room nurses are seeking to control nursing practice in the operating room to protect the public and the nurse is demonstrated through the development of standards. Standards are used as a basic model to measure the quality of operating room nursing care. They are broad in scope, relevant, attainable, and definitive. The administrative standards should be used in conjunction with existing Standards of Nursing Practice: Operating Room‘ and the Standards of Technical and Aseptic Practice: Operating Room established by AORN.* The Standards of Nursing Practice: Operating Room are based on the nursing process and encompass nursing activities directed toward preoperative assessment and preparation, intraoperative intervention, and postoperative evaluation. Standards of Technical and Aseptic Practice are based on principles of microbiology, validation in literature, and research, and are directed toward providing a safe operating room environment for the patient. The “Standards of Administrative Nursing Practice: Operating Room” provide a basic model of structural standards by which the quality of administration of the operating room may be evaluated. They serve as guidelines for the development of a reliable means of providing good administrative care. Definition. Administrative operating room nursing practice is the coordination of all functions relating to the nursing care of patients experiencing surgical intervention. The person charged with administrative responsibility in the operating room must be a registered nurse who acquires management skills through education and experience. In addition, he or she must have experience and expertise in operating room nursing. Management skills encompass the ability to plan (determine in advance what should be done); organize (determine where and in what sequence the work should be done); direct or activate the plan (apply human force to the work); control (determine if the work has been done); and evaluate (appraise the care given). Inherent in management is recognizing the balance between accomplishing the work and
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meeting human needs through effective interpersonal relations. The administrator must possess leadership qualities and demonstrate flexibility, receptiveness, and the ability to instill selfconfidence in others.
Standard 1. A philosophy and Objectives shall be formulated to guide the activities of the operating room. Criteria 1. The philosophy is based on the philosophy of the institution and nursing service. 2. The philosophy reflects the meaning of nursing practice in the operating room. 3. The objectives are measurable and are used to implement the philosophy. 4. The philosophy and objectives are in writing, widely distributed, and interpreted to all operating room personnel. 5. The philosophy and objectives are periodically reviewed, revised, and updated. 6. Operating room personnel share in the formulation, review, and revision of the philosophy and objectives.
Standard 11. There shall be efficient utilization of the operating suite and personnel. Criteria 1. New staffing patterns are based on the type and number of procedures and the length of the operation. 2. The staffing ratio of professional to nonprofessionalworkers insures direct professional nursing supervision of patient care and application of aseptic technique at all times. 3. New staffing patterns are developed in consultation with the supervisors, assistants, and nursing and hospital administration. 4. Operating room personnel are assigned to operative procedures based on their level of competence and the specific needs of patients having operative procedures. 5. A plan is instituted when emergency surgery and extended procedures result in schedule delays. The plan includes notification of appropriate personnel and units. 6. Operating room scheduling is coordinated with other hospital departments. These include, but are not limited to: a. Recovery room and other nursing care units b. Laboratory c. X-ray 7. Personnel other than nurses are utilized in clerical, housekeeping, and other indirect service roles. 8. There is an ongoing evaluation of operating room utilization which includes, but is not limited to: a. Type of case b. Length of case c. Time lapse between cases d. Reason for delays e. Length of operating room day (eg, 8 hours, 10 hours, 16 hours)
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Standard 111. Records and reports essential to providing safe care to surgical patients will be kept in the operating room and utilized. Criteria 1. Records of operations performed and daily case loads, and other records are used for: a. Statistical information that includes, but is not limited to: 1) Members of OR team 2) Pre and postoperative diagnosis 3) Operative procedure 4) Length of time involved in the procedure b. Infection control (eg, breaks in technique) c. Reference sources d. Legal documentations (eg, sponge, needle, and instrument counts signed by a registered nurse) e. Budget preparation 2. Recorded information is examined to assist in planning and organizing the operating room more efficiently. 3. Records are used to provide information for reports (eg, annual report, yearly statistical reports, monthly reports). 4. An operative record is kept that contains facts relating to the direct care of each patient and information required by standard coding systems. This includes, but is not limited to: a. Patient's name b. Patient's hospital number c. Surgeon d. Anesthesiologist e. Assistant to surgeon f. Preoperative diagnosis g. Postoperative diagnosis h. Scrub and circulating nurse i. Operative procedure j. Sponge, needle, and instrument counts k. Wound status I. Specimen m. Complications 5. Reports are used as a method of communication for: a. Minutes of operating room committee b. Recording information that must be kept on file c. Transmitting information on technique or practice d. Announcing policy, rules, decisions, and meetings 6. The operating room administration collaborates with the medical records department in maintaining and controlling the records required by the hospital and by legal statute. Standard IV. The operating room shall have a budget that is used to plan, forecast, and control cost. Criteria 1. The budget predicts the number and types of surgical procedures to be performed, the income from these procedures, and the cost incurred in performing them. The procedures are influenced by, but not limited to, the following factors: a. New procedures anticipated
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b. Surgical staffing changes c. Increases and decreases in hospital beds or types of beds 2. The budget is periodically reviewed with: a. Administration to be informed of overall budgetary limitations or extensions b. Operating room committee to coordinate the use of procurement of specialty supplies and equipment c. Operating room staff to promote conscientiousness and understanding of financial requirements 3. The budget is developed by, but not limited to, utilizing the following: a. Accounting facts and figures b. Comparative monthly financial statements showing actual cost c. Salary and wage adjustments d. Allowance for supply cost increases e. Innovations and projected technique changes 1. Standard depreciation factor of major equipment items 4. The objectives of nursing care are utilized as the determinant in forecasting the operating room budget. 5. The budget is evaluated and revised as necessary to control expenditures. Standard V. A safe operating room environment shall be established, controlled, and consistently monitored. Criteria 1. Technical standards are established, maintained, and periodically reviewed. These include, but are not limited to: a. Sanitation b. Inhospital packaging material c. Sponge, needle, and instrument counts d. OR wearing apparel e. Draping and gowning materials f. Preoperative skin preparation of patients g. Surgical hand scrubs 2. Bacteriological monitoring is done to: a. Establish a baseline b. Monitor the environment c. Investigate specific problems 3. Electrical safety is monitored periodically by adequately trained individuals and is consistent with accepted regional, national, and hospital standards. 4. Potential explosive hazards are detected, reported, and eliminated by proper means. 5. Occupational safety for the employee is maintained by: a. Provisions for first aid b. Chest x-ray and immunization programs c. Health insurance coverage d. Safety programs and reviews e. Radiation monitoring and protection f. Proper body mechanics g. Static electricity control h. Proper scavenging systems for waste anesthetic gases
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i. Occupational Safety and Health Administration (OSHA) regulation compliance 6. Physical facilities are maintained by: a. Temperature control within acceptable ranges b. Humidity control within acceptable ranges c. Adequate air circulation and filtration systems d. Proper maintenance of air filtering system e. Fire alert systems f. Constantly monitored steam system g. Constantly monitored oxygen and other gas systems h. Constantly monitored vacuum system i. Adequate plumbing system j. Automatic auxiliary power system k. Security system 7. Guidelines and regulations, established by the following, are utilized for operating room safety: a. Governing boards b. Licensing agencies c. National Fire Protection Agency (NFPA) d. Joint Commission on Accreditation of Hospitals (JCAH) e. Occupational Safety and Health Administration (OSHA) f. US Department of Health, Education, and Welfare (HEW) and Medicare Standard VI. The operating room shall have written policies and procedures that serve as operational guidelines for the provisions of efficient and safe care to patients having surgery. Criteria 1. Policies are written, dated, and enforceable. 2. Policies have the support of administration and/or the surgical committee. 3. Personnel are informed and aware of the original purpose of the policy and its practical application. 4. Policies that become obsolete and not enforceable must be deleted from the policy manual. 5. Policies for the operating room shall include, but are not limited to: a. Operative and special consents 1) Sterilization and abortion 2) Transplant 3) Supportive 4) General b. Fire and disaster plans c. Environmental control d. Visitors and traffic control e. Safety regulations 6. Policy and procedure manuals are available and include, but are not limited to: a. Personnel policies b. Hospital policies-rules and regulations c. Operating room policy manual d. Operating room procedure book 7. Policies and procedures are periodically reviewed, updated, and revised.
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8. Policies and procedures are interpreted to all operating room personnel. 9. Procedures are used to: a. Set standards for appraisal b. Produce predicatable outcomes c. Analyze currently used methods d. Standardize e. Teach f. Reduce errors 10. Operating room personnel share in the formulation, review, and revision of policies and procedures. 11. Procedures for the operating room shall include, but are not limited to: a. OR sanitation b. Care and disposal of surgical specimens, cultures, and foreign bodies c. Care of special equipment, including preventive maintenance contracts and records, where necessary d. Emergency action, eg, cardiac arrest Standard VII. Staff development shall utilize teaching-learning processes, and be constant and ongoing. Criteria 1. Orientation programs are established and offered to all newly employed personnel. Content includes, but is not limited to: a. Philosophy and objectives of institution, nursing service and operating room b. Policies and procedures of practice c. Job descriptions d. Personnel policies 2. Regularly scheduled inservice programs are conducted for all personnel and include, but are not limited to: a. Periodic review of existing aseptic and nursing practices b. Obtaining new knowledge and skills applicable to operating room nursing c. Discussing problems and keeping personnel informed of changes in policies and procedures in the hospital and department 3. Continued learning experiences are encouraged for individual practitioners to insure current knowledge and practice. 4. Formal and informal counseling is employed, providing a climate for open communication, leading to employee development and satisfaction. 5. All interviews and counseling are documented, signed by the principals, and placed in the employee’s personnel file. 6. Provision is made for implementation of Standards of Nursing Practice: Operating Room and other guidelines accepted by the profession. 7. Involvement in professional organizations and activities is encouraged including, but not limited to: a. Reading professional journals b. Participation in educational programs and meetings
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c. Colleague interchange d. Application of knowledge gained. Standard VIII. Evaluation of employees, patient care, and products shall be objective, ongoing, and according to preset criteria. Criteria 1. Job descriptions and analyses are written, current, and approved by administration and/or the personnel department. These are reviewed periodically and revised according to changing demands. 2. Employee performance reviews are conducted on a regular periodic basis, utilizing counseling techniques and providing a climate for open communication leading to employee development. 3. Evaluation of operating room nursing practice is accomplished through various processes of quality assurance, such as audit, peer review, and performance evaluation. 4. Systematic investigations and problem solving are initiated and supported as methods by which to improve patient care. 5. Product evaluation includes, but is not limited to: a. Monitoring all products in use for defects and inefficiencies and reporting serious malfunctions to purchasing and concerned industry for follow-up b. Investigating new products c. Keeping accurate records of product evaluation d. Informing personnel of changes resulting from evaluation 8. Encouraging personnel to participate in evaluations 6. Communication with industry is maintained to provide more effective service to the patient through: a. Service and maintenance b. Education in use of supplies and equipment c. Quality control d. Research and development of new products Notes 1. Association of Operating Room Nurses and American Nurses' Association Division on Medical-Surgical Nursing Practice, Standards of Nursing Practice: Operating Room (Kansas City, Mo: American Nurses' Association, 1975). 2. "AORN Standards: OR wearing apparel, draping and gowning materials," AORN Journal .21 (March 1975) 594-598; "AORN standards for OR
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sanitation," AORN Journal 21 (June 1975) 12281231; "Standards for sponge, needle, and instrument procedures," AORN Journal 23 (May 1976) 971; "Standards for preoperative skin preparation of patients," AORN Journal 23 (May 1976) 974; "Standards for surgical hand scrubs," AORN Journal 23 (May 1976) 976; "Standards for inhospital packaging materials," AORN Journal 23 (May 1976) 980.
AORN Journal, June 1976, Vol23, No 7
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meeting human needs through effective interpersonal relations. The administrator must possess leadership qualities and demonstrate flexibility, receptiveness, and the ability to instill selfconfidence in others.
Standard 1. A philosophy and Objectives shall be formulated to guide the activities of the operating room. Criteria 1. The philosophy is based on the philosophy of the institution and nursing service. 2. The philosophy reflects the meaning of nursing practice in the operating room. 3. The objectives are measurable and are used to implement the philosophy. 4. The philosophy and objectives are in writing, widely distributed, and interpreted to all operating room personnel. 5. The philosophy and objectives are periodically reviewed, revised, and updated. 6. Operating room personnel share in the formulation, review, and revision of the philosophy and objectives.
Standard 11. There shall be efficient utilization of the operating suite and personnel. Criteria 1. New staffing patterns are based on the type and number of procedures and the length of the operation. 2. The staffing ratio of professional to nonprofessionalworkers insures direct professional nursing supervision of patient care and application of aseptic technique at all times. 3. New staffing patterns are developed in consultation with the supervisors, assistants, and nursing and hospital administration. 4. Operating room personnel are assigned to operative procedures based on their level of competence and the specific needs of patients having operative procedures. 5. A plan is instituted when emergency surgery and extended procedures result in schedule delays. The plan includes notification of appropriate personnel and units. 6. Operating room scheduling is coordinated with other hospital departments. These include, but are not limited to: a. Recovery room and other nursing care units b. Laboratory c. X-ray 7. Personnel other than nurses are utilized in clerical, housekeeping, and other indirect service roles. 8. There is an ongoing evaluation of operating room utilization which includes, but is not limited to: a. Type of case b. Length of case c. Time lapse between cases d. Reason for delays e. Length of operating room day (eg, 8 hours, 10 hours, 16 hours)
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Standard 111. Records and reports essential to providing safe care to surgical patients will be kept in the operating room and utilized. Criteria 1. Records of operations performed and daily case loads, and other records are used for: a. Statistical information that includes, but is not limited to: 1) Members of OR team 2) Pre and postoperative diagnosis 3) Operative procedure 4) Length of time involved in the procedure b. Infection control (eg, breaks in technique) c. Reference sources d. Legal documentations (eg, sponge, needle, and instrument counts signed by a registered nurse) e. Budget preparation 2. Recorded information is examined to assist in planning and organizing the operating room more efficiently. 3. Records are used to provide information for reports (eg, annual report, yearly statistical reports, monthly reports). 4. An operative record is kept that contains facts relating to the direct care of each patient and information required by standard coding systems. This includes, but is not limited to: a. Patient's name b. Patient's hospital number c. Surgeon d. Anesthesiologist e. Assistant to surgeon f. Preoperative diagnosis g. Postoperative diagnosis h. Scrub and circulating nurse i. Operative procedure j. Sponge, needle, and instrument counts k. Wound status I. Specimen m. Complications 5. Reports are used as a method of communication for: a. Minutes of operating room committee b. Recording information that must be kept on file c. Transmitting information on technique or practice d. Announcing policy, rules, decisions, and meetings 6. The operating room administration collaborates with the medical records department in maintaining and controlling the records required by the hospital and by legal statute. Standard IV. The operating room shall have a budget that is used to plan, forecast, and control cost. Criteria 1. The budget predicts the number and types of surgical procedures to be performed, the income from these procedures, and the cost incurred in performing them. The procedures are influenced by, but not limited to, the following factors: a. New procedures anticipated
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b. Surgical staffing changes c. Increases and decreases in hospital beds or types of beds 2. The budget is periodically reviewed with: a. Administration to be informed of overall budgetary limitations or extensions b. Operating room committee to coordinate the use of procurement of specialty supplies and equipment c. Operating room staff to promote conscientiousness and understanding of financial requirements 3. The budget is developed by, but not limited to, utilizing the following: a. Accounting facts and figures b. Comparative monthly financial statements showing actual cost c. Salary and wage adjustments d. Allowance for supply cost increases e. Innovations and projected technique changes 1. Standard depreciation factor of major equipment items 4. The objectives of nursing care are utilized as the determinant in forecasting the operating room budget. 5. The budget is evaluated and revised as necessary to control expenditures. Standard V. A safe operating room environment shall be established, controlled, and consistently monitored. Criteria 1. Technical standards are established, maintained, and periodically reviewed. These include, but are not limited to: a. Sanitation b. Inhospital packaging material c. Sponge, needle, and instrument counts d. OR wearing apparel e. Draping and gowning materials f. Preoperative skin preparation of patients g. Surgical hand scrubs 2. Bacteriological monitoring is done to: a. Establish a baseline b. Monitor the environment c. Investigate specific problems 3. Electrical safety is monitored periodically by adequately trained individuals and is consistent with accepted regional, national, and hospital standards. 4. Potential explosive hazards are detected, reported, and eliminated by proper means. 5. Occupational safety for the employee is maintained by: a. Provisions for first aid b. Chest x-ray and immunization programs c. Health insurance coverage d. Safety programs and reviews e. Radiation monitoring and protection f. Proper body mechanics g. Static electricity control h. Proper scavenging systems for waste anesthetic gases
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i. Occupational Safety and Health Administration (OSHA) regulation compliance 6. Physical facilities are maintained by: a. Temperature control within acceptable ranges b. Humidity control within acceptable ranges c. Adequate air circulation and filtration systems d. Proper maintenance of air filtering system e. Fire alert systems f. Constantly monitored steam system g. Constantly monitored oxygen and other gas systems h. Constantly monitored vacuum system i. Adequate plumbing system j. Automatic auxiliary power system k. Security system 7. Guidelines and regulations, established by the following, are utilized for operating room safety: a. Governing boards b. Licensing agencies c. National Fire Protection Agency (NFPA) d. Joint Commission on Accreditation of Hospitals (JCAH) e. Occupational Safety and Health Administration (OSHA) f. US Department of Health, Education, and Welfare (HEW) and Medicare Standard VI. The operating room shall have written policies and procedures that serve as operational guidelines for the provisions of efficient and safe care to patients having surgery. Criteria 1. Policies are written, dated, and enforceable. 2. Policies have the support of administration and/or the surgical committee. 3. Personnel are informed and aware of the original purpose of the policy and its practical application. 4. Policies that become obsolete and not enforceable must be deleted from the policy manual. 5. Policies for the operating room shall include, but are not limited to: a. Operative and special consents 1) Sterilization and abortion 2) Transplant 3) Supportive 4) General b. Fire and disaster plans c. Environmental control d. Visitors and traffic control e. Safety regulations 6. Policy and procedure manuals are available and include, but are not limited to: a. Personnel policies b. Hospital policies-rules and regulations c. Operating room policy manual d. Operating room procedure book 7. Policies and procedures are periodically reviewed, updated, and revised.
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8. Policies and procedures are interpreted to all operating room personnel. 9. Procedures are used to: a. Set standards for appraisal b. Produce predicatable outcomes c. Analyze currently used methods d. Standardize e. Teach f. Reduce errors 10. Operating room personnel share in the formulation, review, and revision of policies and procedures. 11. Procedures for the operating room shall include, but are not limited to: a. OR sanitation b. Care and disposal of surgical specimens, cultures, and foreign bodies c. Care of special equipment, including preventive maintenance contracts and records, where necessary d. Emergency action, eg, cardiac arrest Standard VII. Staff development shall utilize teaching-learning processes, and be constant and ongoing. Criteria 1. Orientation programs are established and offered to all newly employed personnel. Content includes, but is not limited to: a. Philosophy and objectives of institution, nursing service and operating room b. Policies and procedures of practice c. Job descriptions d. Personnel policies 2. Regularly scheduled inservice programs are conducted for all personnel and include, but are not limited to: a. Periodic review of existing aseptic and nursing practices b. Obtaining new knowledge and skills applicable to operating room nursing c. Discussing problems and keeping personnel informed of changes in policies and procedures in the hospital and department 3. Continued learning experiences are encouraged for individual practitioners to insure current knowledge and practice. 4. Formal and informal counseling is employed, providing a climate for open communication, leading to employee development and satisfaction. 5. All interviews and counseling are documented, signed by the principals, and placed in the employee’s personnel file. 6. Provision is made for implementation of Standards of Nursing Practice: Operating Room and other guidelines accepted by the profession. 7. Involvement in professional organizations and activities is encouraged including, but not limited to: a. Reading professional journals b. Participation in educational programs and meetings
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c. Colleague interchange d. Application of knowledge gained. Standard VIII. Evaluation of employees, patient care, and products shall be objective, ongoing, and according to preset criteria. Criteria 1. Job descriptions and analyses are written, current, and approved by administration and/or the personnel department. These are reviewed periodically and revised according to changing demands. 2. Employee performance reviews are conducted on a regular periodic basis, utilizing counseling techniques and providing a climate for open communication leading to employee development. 3. Evaluation of operating room nursing practice is accomplished through various processes of quality assurance, such as audit, peer review, and performance evaluation. 4. Systematic investigations and problem solving are initiated and supported as methods by which to improve patient care. 5. Product evaluation includes, but is not limited to: a. Monitoring all products in use for defects and inefficiencies and reporting serious malfunctions to purchasing and concerned industry for follow-up b. Investigating new products c. Keeping accurate records of product evaluation d. Informing personnel of changes resulting from evaluation 8. Encouraging personnel to participate in evaluations 6. Communication with industry is maintained to provide more effective service to the patient through: a. Service and maintenance b. Education in use of supplies and equipment c. Quality control d. Research and development of new products Notes 1. Association of Operating Room Nurses and American Nurses' Association Division on Medical-Surgical Nursing Practice, Standards of Nursing Practice: Operating Room (Kansas City, Mo: American Nurses' Association, 1975). 2. "AORN Standards: OR wearing apparel, draping and gowning materials," AORN Journal .21 (March 1975) 594-598; "AORN standards for OR
1208
sanitation," AORN Journal 21 (June 1975) 12281231; "Standards for sponge, needle, and instrument procedures," AORN Journal 23 (May 1976) 971; "Standards for preoperative skin preparation of patients," AORN Journal 23 (May 1976) 974; "Standards for surgical hand scrubs," AORN Journal 23 (May 1976) 976; "Standards for inhospital packaging materials," AORN Journal 23 (May 1976) 980.
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