Editorial
OR nursing audit a means for effecting change Are nurses in the operating room satisfied with the care they give? Sometimes they wish they could do things differently. “It is impersonal, it is push, push, push. We feel uncomfortable,” commented one nurse at a recent AORN nursing audit seminar. Yet, how can nurses effect change in their practice? The staff may believe that something should be changed, but the supervisor may not agree. Or the supervisor may want some change but finds it difficult to get her staff’s support. Nursing audit is not only a means of evaluating nursing care, but it is also an effective mechanism for creating change. Because audit is an activity of nurse peers, it can break down some of the structural barriers to change. Since 1973, AORN has done a great deal to help its members develop audit tools and improve patient care in the operating room. As a basis for audit, AORN first developed Standards for Nursing Practice: Opemting Room, published in collaboration with the American Nurses’ Association. An AORN ad hoc committee, under the leadership of Board member Barbara J Gruendemann, developed guidelines for an audit tool and then asked members to evaluate them. Based on this information and additional study, the committee refined the guidelines and pub-
lished the manual Nursing Audit: Challenge to the Operating Room Nurse in 1974. In addition, AORN has offered seminars on nursing audit to help nurses initiate programs in their hospitals. In the August 1974 AORN Journal, several articles reported on AORN’s progress on audit. In this issue, we are updating AORN’s activities. AORN’s first audit tool was based on the process of nursing care as it was delivered in the OR. An auditor observed this care and documented it. But the audit committee wanted to go further and look at patient outcomes. Could nursing activities be identified and related to patient outcomes? In 1974, with the Western Interstate Commission for Higher Education (WICHE), AORN undertook a research study to measure the quality of nursing as it related to the operating room. AORN representatives were Barbara Gruendemann, Mary Van Poole, Julie Kneedler, Carolyn Enloe, Mary Nolan, Millie Harmon, and Linda Funderburk. Carol Lindeman was the contact person and served as the research consultant. Their first task was to identify nursing activities that could be measured. When Linda Funderburk reported at Congress last year on the AORN-WICHE work, she described how the nine activities were selected. Dividing activities into preoperative, intraoperative, and postoperative phases, the committee listed every conceivable nursing activity from explanation of the OR experience to cleaning floors and dusting fixtures. Then the committee had to consider what activities influenced
AORN Journal, September 1977, Vol26, No 3
421
patients’ health status. From a list of 151, the committee narrowed the list down to 28 items, then finally selected these 9. 1. preoperative teaching 2. preoperative interview 3. communication of intraoperative information 4. psychological support 5. physical support 6. positioning 7. placement of grounding plate 8. maintaining of efficient, effective, and safe intraoperative environment 9. sponge count. Funderburk pointed out that these activities were not necessarily the most important activities but those “we felt we would be able to measure.” Then came the difficult part of determining patient outcomes. After one meeting, Funderburk recalls, “We went home from this meeting mentally exhausted. We had come to the realization that still another review of the literature was needed to determine immediate end-result outcomes.” First, the committee decided to group outcomes in terms of systems, but when it met four months later, it rejected this and decided to list symptoms. For example, in the final tool, nurses are instructed to inspect the skin of the head and neck for edema, blisters, bruises, burns, cuts and excoriation, discoloration, grayish color, and moistness. The nursing activity and outcome tools were sent to 25 hospitals, and 200 patients experiencing general abdominal surgery were studied. The data have now been collected and the committee has been working to put the information together. A report will be published in a future Journal, and the committee plans to develop a tool for outcome audit that will also be published in the Journal. In updating nursing audit, this issue of the Journal offers several articles that should be helpful. AORN Board member Elizabeth A Reed writes how an audit program was implemented at University of California, San Francisco Moffitt Hospital. She will convince you that nursing audit can become a reality for your hospital. When I attended the AORN nursing audit seminar, I learned how confusing it can be to
428
try to write good criteria. As a result, I was pleased when we received a series of articles from Anna Schmidt and Carol Deets on writing criteria. The first article is on writing measurable criteria. For our members who are recovery room nurses, Edwina McConnell writes about an audit tool developed at Madison General Hospital, WIS. As we were planning this issue, I talked with Julie Kneedler, who is the AORN nursing audit seminar leader. “After you organize your audit committee, write criteria, collect and analyze data, what happens next?” I asked her, “How do you translate this information into better nursing?” As a result of this conversation, Julie has written an article on how audit is used to change nursing practice in the operating room. As she points out, this is the step that makes the quality assurance cycle complete. She shows in detail how audit results can be used to reinforce what is good about current nursing practice and how to change what you are not satisfied with. These articles reflect the increasing sophistication of nursing audit in the operating room. Make good use of them.
AORN Journal, September 1977, Vol26, No 3
Elinor S Schrader Editor
OR nursing audit a means for effecting change Are nurses in the operating room satisfied with the care they give? Sometimes they wish they could do things differently. “It is impersonal, it is push, push, push. We feel uncomfortable,” commented one nurse at a recent AORN nursing audit seminar. Yet, how can nurses effect change in their practice? The staff may believe that something should be changed, but the supervisor may not agree. Or the supervisor may want some change but finds it difficult to get her staff’s support. Nursing audit is not only a means of evaluating nursing care, but it is also an effective mechanism for creating change. Because audit is an activity of nurse peers, it can break down some of the structural barriers to change. Since 1973, AORN has done a great deal to help its members develop audit tools and improve patient care in the operating room. As a basis for audit, AORN first developed Standards for Nursing Practice: Opemting Room, published in collaboration with the American Nurses’ Association. An AORN ad hoc committee, under the leadership of Board member Barbara J Gruendemann, developed guidelines for an audit tool and then asked members to evaluate them. Based on this information and additional study, the committee refined the guidelines and pub-
lished the manual Nursing Audit: Challenge to the Operating Room Nurse in 1974. In addition, AORN has offered seminars on nursing audit to help nurses initiate programs in their hospitals. In the August 1974 AORN Journal, several articles reported on AORN’s progress on audit. In this issue, we are updating AORN’s activities. AORN’s first audit tool was based on the process of nursing care as it was delivered in the OR. An auditor observed this care and documented it. But the audit committee wanted to go further and look at patient outcomes. Could nursing activities be identified and related to patient outcomes? In 1974, with the Western Interstate Commission for Higher Education (WICHE), AORN undertook a research study to measure the quality of nursing as it related to the operating room. AORN representatives were Barbara Gruendemann, Mary Van Poole, Julie Kneedler, Carolyn Enloe, Mary Nolan, Millie Harmon, and Linda Funderburk. Carol Lindeman was the contact person and served as the research consultant. Their first task was to identify nursing activities that could be measured. When Linda Funderburk reported at Congress last year on the AORN-WICHE work, she described how the nine activities were selected. Dividing activities into preoperative, intraoperative, and postoperative phases, the committee listed every conceivable nursing activity from explanation of the OR experience to cleaning floors and dusting fixtures. Then the committee had to consider what activities influenced
AORN Journal, September 1977, Vol26, No 3
421
patients’ health status. From a list of 151, the committee narrowed the list down to 28 items, then finally selected these 9. 1. preoperative teaching 2. preoperative interview 3. communication of intraoperative information 4. psychological support 5. physical support 6. positioning 7. placement of grounding plate 8. maintaining of efficient, effective, and safe intraoperative environment 9. sponge count. Funderburk pointed out that these activities were not necessarily the most important activities but those “we felt we would be able to measure.” Then came the difficult part of determining patient outcomes. After one meeting, Funderburk recalls, “We went home from this meeting mentally exhausted. We had come to the realization that still another review of the literature was needed to determine immediate end-result outcomes.” First, the committee decided to group outcomes in terms of systems, but when it met four months later, it rejected this and decided to list symptoms. For example, in the final tool, nurses are instructed to inspect the skin of the head and neck for edema, blisters, bruises, burns, cuts and excoriation, discoloration, grayish color, and moistness. The nursing activity and outcome tools were sent to 25 hospitals, and 200 patients experiencing general abdominal surgery were studied. The data have now been collected and the committee has been working to put the information together. A report will be published in a future Journal, and the committee plans to develop a tool for outcome audit that will also be published in the Journal. In updating nursing audit, this issue of the Journal offers several articles that should be helpful. AORN Board member Elizabeth A Reed writes how an audit program was implemented at University of California, San Francisco Moffitt Hospital. She will convince you that nursing audit can become a reality for your hospital. When I attended the AORN nursing audit seminar, I learned how confusing it can be to
428
try to write good criteria. As a result, I was pleased when we received a series of articles from Anna Schmidt and Carol Deets on writing criteria. The first article is on writing measurable criteria. For our members who are recovery room nurses, Edwina McConnell writes about an audit tool developed at Madison General Hospital, WIS. As we were planning this issue, I talked with Julie Kneedler, who is the AORN nursing audit seminar leader. “After you organize your audit committee, write criteria, collect and analyze data, what happens next?” I asked her, “How do you translate this information into better nursing?” As a result of this conversation, Julie has written an article on how audit is used to change nursing practice in the operating room. As she points out, this is the step that makes the quality assurance cycle complete. She shows in detail how audit results can be used to reinforce what is good about current nursing practice and how to change what you are not satisfied with. These articles reflect the increasing sophistication of nursing audit in the operating room. Make good use of them.
AORN Journal, September 1977, Vol26, No 3
Elinor S Schrader Editor
