AORN Guideline Updates Focus on Counting, Communication to Prevent RSIs

Using a new evidence review model, AORN highlights key safety concerns, while one expert calls for more emphasis on human error.

Using a new evidence review model, updated guidelines released by one of the nation’s leading surgical associations underscore the importance of clear communication and strong counting procedures to prevent the occurrence of retained surgical items (RSI).

The Association of periOperative Registered Nurses (AORN) released updates to its Guideline for Prevention of Retained Surgical Items effective January 15, 2016. The updated guidelines take the place of previous recommendations released in 2012.

Hospitals continue to struggle with RSIs. In January, The Joint Commission released a “Quick Safety” report building on its 2013 Sentinel Event Alert on unintended retained foreign objects (URFO). The Joint Commission reported that URFOs accounted for 115 of the sentinel events reported in 2015 and 112 in 2014, up from 102 in 2013.

Perhaps the most notable change to the guidelines is the inclusion of a new evidence rating model which is based on the Institute of Medicine’s Standards for Developing Trustworthy Clinical Practice Guidelines. Each recommendation includes an assigned score based on an independent evaluation of all relevant research. For example, recommendations assigned an appraisal score of “1” signify strong supporting evidence and a regulatory requirement. Those assigned a “5” have weaker evidence, or “benefits balanced with harms,” according to AORN. It’s an approach that is often used by other health organizations such as the CDC, which adds more weight to the updated recommendations, says Ramona Conner, MSN, RN, CNOR, editor and chief of the AORN guidelines.

“We’ve always included and discussed evidence in the literature, but we have a more formal way of doing that now,” she says, noting that the guideline includes 222 supporting references. “There’s quite a bit more information related to evidence that supports the recommendations in this new version.”

The guidelines emphasize the importance of using a consistent counting process and the ability to minimize distractions, noise, and interruptions during that process. Recommendations also hone in on the importance of a team-based approach to RSI prevention and the need for effective communication.

This is an excerpt from the April issue of Patient Safety Monitor. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.