Revising the Perioperative Nursing Data Set - Clinical Innovations

AORN Journal,  March, 2002  by Susan V.M. Kleinbeck

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Format change example: Interim outcome statements. The addition of interim outcome statement examples linked to each PNDS outcome in the new edition was prompted by the realization that all of the PNDS outcomes cannot be met at the end of the intraoperative phase or at the time of discharge from the postanesthesia care unit (PACU). (4) For example, nurses cannot document an outcome related to an absence of infection after a patient is exposed to microorganisms during an operative or invasive procedure. Although intraoperative nurses work hard to achieve the outcome, the first manifestation of a surgical wound infection may not be exhibited until three to five days postoperatively. (5) Documentation that the patient is free from surgical site infection at discharge from the OR or the PACU therefore is meaningless. For this reason, examples of interim outcome statements are included in the new edition for each PNDS outcome.

Interim outcome statements represent progress toward the PNDS expected outcome (ie, the patient's status at the time of transfer to another caregiver or setting). Interim patient outcome statements reflect the patient's condition, not what the nurse does. Example interim outcome statements about infection published in the new edition include

* the patient has a clean, primarily closed surgical wound covered with a dry, sterile dressing at discharge from the OR;

* the patient has a Class III wound covered with a dry, sterile dressing on admission to the PACU; and

* the patient's immune status remains within expected levels five days after surgery.

With the new edition, perioperative nurses can indicate accurately the actual status in relationship to an outcome of the patient at the time of transfer from the OR or PACU.

Outcomes retired. Three outcomes and their corresponding codes were retired, including physical injury (ie, O1), knowledge of physiological responses (ie, O16), and knowledge of psychological responses (ie, O17). The first outcome (ie, O1) was retired because of levels of abstraction and the second two (ie, O16, O17) because of standardization requirements.

Whether a patient is harmed by extraneous objects, electricity, radiation, or laser, or during positioning, the acquired injury is physical; therefore, all injury outcomes should be considered a physical injury. For these reasons, the definition of physical injury was raised to the domain level, a domain extension was created to reflect acquired physical injury, and the outcome was retired. All interventions formerly listed under the retired outcome were linked to other injury outcomes. For example, "verifies presence of prostheses or corrective devices" (ie, I127) was linked to the positioning outcome (ie, O5).

The outcomes "The patient demonstrates knowledge of the physiological response (ie, O16) and psychological response (ie, O17) to the operative or other invasive procedure" were combined into "The patient demonstrates knowledge of expected responses to the operative or other invasive procedure" (ie, O31). Outcomes O16 and O17 were retired because