Recommended practices for safe care through identification of potential hazards in the surgical environment

AORN Journal,  March, 2003  

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The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They are effective Jan 1, 2003.

These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.

AORN recognizes the numerous types of settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed.

Purpose: These recommended practices provide guidelines for the implementation of safe care to patients and assist in the identification of potential hazards in the practice setting. They are not intended to cover aspects of perioperative patient care addressed in other recommended practices.

RECOMMENDED PRACTICE I

Potential hazards associated with patient transport/transfer activities should be identified, and safe practices should be established.

1. The patient always should be attended by appropriate personnel during transport and transfer. Patient needs should be assessed by an RN before transport to determine the necessary skill level of transport personnel. Many patient care problems can occur during transport. Observation and assessment by a registered professional nurse allows for identification of potential problems and implementation of appropriate interventions. (1)

2. When selecting the appropriate transport vehicle, design features to be considered include, but are not limited to,

* locking devices on wheels;

* protective devices such as safety straps and

* side rails and for cribs rails high enough to prevent a standing child from falling out;

* stable, adjustable IV poles or stands;

* holding devices for oxygen tanks;

* positioning capabilities;

* controls that are easy to operate and within reach of the operator;

* maneuverability;

* sufficient size;

* removable head and foot boards;

* mattress stabilizing devices;

* easily cleanable surfaces; and

* a rack or shelf to hold monitoring equipment.

These design features promote safety and help prevent injury to patients and staff members during transport. (2)

3. The transporter should demonstrate competency in operating transport equipment. Demonstrated competency in operating transport equipment is necessary to prevent harm to the patient and operator. (3)

4. An adequate number of staff members should be available to ensure patient and staff member safety during transport/transfer activities. Individual patient assessment will dictate the number of staff members needed. (4) A minimum of four staff members is needed to move an adult who is unable to assist with transfer. (5)

To promote the safety of patients and staff members, patient movement devices may be useful. If mechanical devices are not available, extra personnel may be needed. Safety devices include, but are not limited to,

* roller devices,

* hoists, and/or

* slides. (6)

5. Specific needs of the patient should be assessed and appropriate interventions implemented during the transport phase. (7) Safety measures to be implemented during transport/transfer activities should include, but are not limited to,

* locking wheels on the transport vehicle and the patient's bed during transfer activities;

* elevating side rails and using safety straps;

* hanging and securing IV containers away from the patient's head;

* protecting the patient by giving special attention to the head, arms, and legs;

* ensuring that one staff member remains at the head of the patient transport vehicle;

* pushing the transport vehicle with the patient's feet first, avoiding rapid movement through hallways and when turning corners;

* maintaining integrity and function of IV infusions, indwelling catheters, tubes, drainage systems, and monitoring equipment; and

* obtaining appropriate skilled assistance and specific instructions for the patient with special needs.

Locking wheels, raising the side rails, and securing safety straps prevent the patient from falling. Securing IV containers prevents container breakage and subsequent patient injury. (8) Maintaining proximity to the patient's head provides access to the patient's airway in case of respiratory distress or vomiting. Rapid movements can cause patient disorientation, nausea and vomiting, and dizziness. (9)

6. Scheduled preventive maintenance and repair should be performed on all transport vehicles. Preventive maintenance and repair promote proper functioning. (10)

RECOMMENDED PRACTICE II

Potential hazards associated with controlling patient temperature should be identified, and safe practices should be established.