anatomy of the new evidence-rated aorn recommended practices
DESCRIPTION
This presentation is from an AORN webinar that helps guide perioperative team members through the evidence appraisal and rating process using the AORN appraisal tools and evidence-rating model. The webinar replay is available for free at http://bit.ly/1i9r4En. Get the 2014 edition of Perioperative Standards and Recommended Practices at http://bit.ly/1bJmXAT.TRANSCRIPT
![Page 1: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/1.jpg)
Anatomy of the New
Evidence-Rated AORN
Recommended Practices
![Page 2: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/2.jpg)
Lisa Spruce, DNP, RN, ACNS, ACNP, ANP, CNOR
Dr. Spruce is the Director of Evidence Based Perioperative Practice
for AORN. Prior to coming to AORN she was the Clinical Manager of Surgical
Services for Universal Health Services where she managed all clinical
practice for 25 perioperative departments throughout the U. S. She was
instrumental in bringing evidence based practice changes to the Universal
Health Care System.
Dr. Spruce was a Clinical Nurse Specialist in the Perioperative
Departments for 5 hospitals in Las Vegas and a Nurse Practitioner in private
practice in Florida. She was a circulating nurse in the OR for 6 years and
worked in pre-op, PACU, and in the Endoscopy Suite. She is a board
certified Acute Care Nurse Practitioner, Adult Clinical Nurse Specialist and as
a CNOR. She has published several articles in the AORN Journal and the
Journal for the American Academy of Nurse Practitioners.
![Page 3: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/3.jpg)
Sharon Van Wicklin has more than 36 years of experience as a perioperative nurse. She has
worked in all facets of the operating room environment from scrub person to supervisor. Sharon
received her BSN and MSN from Middle Tennessee State University. She is a member of Phi Kappa
Phi, and the Sigma Theta Tau Honor Society of Nursing. Sharon holds certification in operating room
nursing (CNOR), as an RN first assistant (CRNFA), in plastic and reconstructive surgical nursing
(CPSN), and as a legal nurse consultant (PLNC).
In her previous role as a perioperative educator, Sharon was responsible for the creation and
coordination of educational projects, programs and inservices designed to improve hospital processes
for orientation and development of personnel in nine perioperative departments. Her work as a legal
expert witness involves reading and reviewing medical records and testifying as to the standard of
perioperative nursing care. Sharon is a member of the School of Nursing faculty of Middle Tennessee
State University and the University of Phoenix. She truly enjoys her work as a nursing instructor
helping to shape the hearts and minds of future perioperative nursing professionals.
In her position as a Perioperative Nursing Specialist for the Association of periOperative
Registered Nurses (AORN), Sharon provides consultative services, authors various AORN
publications including recommended practices and Clinical Issues columns; and, represents AORN at
various organizations and functions such as AAMI, IAHCSMM, and AATB. Sharon was recognized by
AORN as a recipient of the Outstanding Achievement in the Application of Perioperative Clinical
Research Award in 2005. This award recognizes a registered nurse whose application of
perioperative clinical research reflects the goal of excellence in patient care.
Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC
![Page 4: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/4.jpg)
Disclosure Information
AORN’s policy is that the subject matter experts for this product must disclose any financial relationship in a company providing grant funds and/or a company whose product(s) may be discussed or used during the educational activity. Financial disclosure will include the name of the company and/or product and the type of financial relationship, and includes relationships that are in place at the time of the activity or were in place in the 12 months preceding the activity. Disclosures for this activity are indicated according to the following numeric categories:
1. Consultant/Speaker’s Bureau 2. Employee
3. Stockholder 4. Product Designer
5. Grant/Research Support 6. Other relationship (specify)
7. Has no financial interest
Speakers:
Lisa Spruce, DNP, RN, ACNS, ACNP, ANP, CNOR
Director of Evidence-Based Practice, AORN
Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA,
CPSN, PLNC
Perioperative Nursing Specialist, AORN
Disclose no conflicts
Accreditation Statement
AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019.
AORN IS PLEASED TO PROVIDE THIS WEBINAR ON THIS IMPORTANT TOPIC. HOWEVER, THE VIEWS
EXPRESSED IN THIS WEBINAR ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY
REPRESENT THE VIEWS OF, AND SHOULD NOT BE ATTRIBUTED TO AORN.
Planning Committee:
Ellice Mellinger, MS, RN, CNOR
Perioperative Education Specialist, AORN
Discloses no conflict
![Page 5: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/5.jpg)
1. Discuss the history of evidence-based
practice.
2. Explain the PICO process for developing a
practice question.
3. Identify research and non-research evidence.
4. Describe the evidence appraisal process using
the AORN Evidence Appraisal Tools.
5. Describe the evidence rating process using
the AORN Evidence Rating Model.
Objectives
![Page 6: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/6.jpg)
History of Evidence-Based
Practice (EBP)
Lisa Spruce, DNP, RN, ACNS, ACNP, ANP, CNOR
Director of Evidence-Based Practice, AORN
![Page 7: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/7.jpg)
“It isn’t what we don’t know that gives us
trouble, it’s what we know that ain’t so.”
~Will Rogers
History of EBP
![Page 8: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/8.jpg)
In the beginning…
Thomas Beddoes (1760-1808)
• Called for sharing medical experiences,
collecting and archiving them and
- Analyzing
- Reporting
- Publishing
![Page 9: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/9.jpg)
In the beginning…
Pierre Charles Alexander Louis (1787-1872)
– Performed the first chart review to disprove
the practice of blood-letting
– Medical science moved from innocence to
awareness
– 20th Century-arrival of the randomized
controlled trial
![Page 10: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/10.jpg)
1948
The first Randomized Controlled Trial (RCT)
• Medical Research Council Tuberculosis
Unit trial of streptomycin treatment for
pulmonary tuberculosis
![Page 11: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/11.jpg)
Archie Cochran
Scottish physician
– "I knew that there was no real evidence that
anything we had to offer had any effect on
tuberculosis, and I was afraid that I shortened
the lives of some of my friends by
unnecessary intervention."
![Page 12: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/12.jpg)
1972
Effectiveness and Efficiency: Random
Reflections on Health Services published
Cardiff University Library, Cochrane Archive,
University Hospital, Llandough
![Page 13: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/13.jpg)
1979
Archie Cochrane states,
“It is surely a great criticism of our
profession that we have not organized a
critical summary, by specialty or
subspecialty, adapted periodically, of all
relevant randomized controlled trials.”
![Page 14: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/14.jpg)
History of EBP
1980’s-
• Oxford Database of Perinatal Trials
1992-
• Cochrane Center opened
1993-
• Cochrane Collaboration founded
![Page 15: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/15.jpg)
Evidence-Based Medicine
Term first used by McMasters University
(Canada)
• 1996-term formally defined by Sackett, et.al.
– “A systematic approach to analyze published
research as the basis of clinical decision making.”
![Page 16: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/16.jpg)
Why EBP?
• It takes an average of 17 years to move
research to practice
• Evidence-based practice (EBP) provides
point of care clinicians tools needed to
improve care
• EBP transforms health care based on one
clinician, one encounter at a time
![Page 17: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/17.jpg)
Evidence-Based Nursing
Dicenso-1998
- “Process by which nurses make clinical
decisions using best available evidence,
clinical expertise and patient preferences
in the context of available resources.”
![Page 18: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/18.jpg)
First Nurse Pioneer for EBP
Florence Nightingale ~ 1860
• Compiled data from the Crimean war on
illness, treatment and cause of death
• Called for the collection of statistics on
hospital outcomes
• Improved sanitary conditions based on
evidence
![Page 19: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/19.jpg)
EBP and Perioperative Nursing
• Quality of care
• Continuous inquiry
• Critical thinking
• Individualized care
• Payer and regulatory pressure
• Savvy patients
![Page 20: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/20.jpg)
Developing the EBP Question
Lisa Spruce, DNP, RN, ACNS, ACNP, ANP, CNOR
Director of Evidence-Based Practice, AORN
![Page 21: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/21.jpg)
PICO Method
PPatientPopulationProblem
IInterventions-Education-Self-care-Best practices
CComparison-Current practice-Another intervention
O Outcome
![Page 22: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/22.jpg)
IM Injections: Aspirate or not?
P Adult patients
I Aspirate when giving
IM injection
C No aspiration
O Injury
Question:
Among adult patients,
does aspirating while
giving an IM injection
cause injury compared
to no aspiration?
![Page 23: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/23.jpg)
Integrative Literature Review
• A simple inquiry leads to a
recommendation for practice!
- Crawford and Johnson-Integrative lit review
reveals that there is no data to support the
use of the aspiration procedure
![Page 24: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/24.jpg)
Surgical Masks: Prevent SSI?
PPatientPopulationProblem
Surgical patients
IInterventions-Education-Self-care-Best practices
Wearing a mask
CComparison-Current practice-Another intervention
No mask
O OutcomeSurgical site
infections
![Page 25: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/25.jpg)
PICO Question
Among surgical patients, does wearing a
surgical mask prevent surgical site
infections compared to not wearing a
mask?
![Page 26: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/26.jpg)
Literature Search
Lisa Spruce, DNP, RN, ACNS, ACNP, ANP, CNOR
Director of Evidence-Based Practice, AORN
Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC
Perioperative Nursing Specialist, AORN
![Page 27: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/27.jpg)
Conducting a Search
Databases Databases
~ Cochrane ~ Google Scholar
~ AHRQ - NGC ~ Joanna Briggs
~ Pubmed ~ Virginia Henderson
~ CINAHL® International Nursing
~ ANA - Medline Library
~ AORN Journal ~ Embase
~ Medical Library
![Page 28: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/28.jpg)
Search Strategies
Strategies
• Define your topic
• Keywords
• Boolean operators
• AND
• OR
• Quotation marks
• Truncation
Results• No or few results
• Avoid long
phrases or
questions
• Choose different
key words
![Page 29: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/29.jpg)
Literature Search
![Page 30: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/30.jpg)
Literature Search Terms
– Sterile field - Sterile supplies
– Sterile technique - Sterile barriers
– Aseptic technique - Barrier precautions
– Aseptic practices - Body-exhaust suits
– Surgical drapes - Laminar air flow
– Double-gloving - Bowel technique
– Assisted gloving - Glove expansion
– Closed gloving - Glove perforation
– Time-related sterilization - Strikethrough
– Event-related sterilization - Spaulding’s criteria
– Surgical attire - Product packaging
– Protective clothing - Equipment contamination
![Page 31: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/31.jpg)
Literature Search
Initial search confined to 2006 to 2011
• Time restriction not considered in subsequent
searches
![Page 32: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/32.jpg)
Literature Search
Documents searched
• Meta-analyses
• Randomized and nonrandomized controlled trials and
studies
• Systematic and nonsystematic reviews
• Opinion documents and letters
• Guidelines (eg, government, professional, standards)
• Additional (eg, articles from reference lists)
• Alerts
![Page 33: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/33.jpg)
Literature Search
Databases searched
• MEDLINE®
• CINAHL®
• Scopus®
• Cochrane
![Page 34: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/34.jpg)
Literature Search
Articles identified: 429
– Rejected: 294
– Accepted: 135
![Page 35: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/35.jpg)
Research Evidence
Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC
Perioperative Nursing Specialist, AORN
![Page 36: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/36.jpg)
Research
Systematic Reviews
Randomized Controlled Trials
Quasi-Experimental Studies
Non-Experimental Studies
Qualitative Studies
![Page 37: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/37.jpg)
Research
Systematic Reviews
• Summarize evidence related to a particular
practice question
• Address strengths and limitations of included
studies
• Review multiple studies
• Utilize rigorous search strategies and precise
appraisal methods
![Page 38: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/38.jpg)
Research
Randomized Controlled Trials (RCTs)
• Randomization
- Researcher assigns subjects to a control or
experimental group on a random basis
- Increases validity of the study
![Page 39: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/39.jpg)
Research
RCTs
• Manipulation
- Researcher takes an action to influence some aspect
of the dependent variable
Independent variable: Intervention being applied
Dependent variable: Phenomenon being studied
![Page 40: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/40.jpg)
Research
RCTs
• Control
- Researcher introduces a group of subjects to which
the experimental intervention is not applied
![Page 41: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/41.jpg)
Research
Quasi-Experimental
• Lack one element of a RCT
(ie, randomization, manipulation, or control)
- Researcher may attempt to compensate by using
multiple groups, or multiple measures
![Page 42: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/42.jpg)
Research
Non-Experimental
• Study naturally occurring phenomenon
• No randomization, manipulation, or control
• Includes
• descriptive (describe observable facts),
• comparative (compare observable facts), and
• correlational (show a relationship) studies.
• Most of nursing research falls into this
category
![Page 43: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/43.jpg)
Research
Qualitative
• Data collection includes interviews, group
discussion, field observation, reflection
• Researchers attempt to explore issues,
answer questions and gain in-depth
understanding of certain phenomena by
summarizing, analyzing and interpreting data
![Page 44: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/44.jpg)
Non-Research Evidence
Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC
Perioperative Nursing Specialist, AORN
![Page 45: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/45.jpg)
Non-Research
Clinical Practice Guidelines
Literature Reviews
Expert Opinion
Case Reports
Organizational Experience
Community Standard/Clinician Experience
![Page 46: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/46.jpg)
Non-Research
Clinical Practice Guidelines
• Systematically developed statements
• Provide guidance for clinical practice
![Page 47: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/47.jpg)
Non-Research
Literature Review
• Summary of published literature without
systematic appraisal of the quality and
strength of the evidence
• May not summarize all available evidence on
the topic in question
![Page 48: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/48.jpg)
Non-Research
Expert Opinion
• Expertise must be assessed
- Education
-Work experience
- University affiliations
- Publications
- Citations
- Recognized speaker
![Page 49: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/49.jpg)
Non-Research
Case Reports
• In-depth look at a single person, group, or
social unit
• Quantitative or qualitative
• Individual case or multiple cases
• Provide insight but have limited
generalizability
![Page 50: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/50.jpg)
Non-Research
Organizational Experience
• Generally the result of efforts to improve
quality of care delivery and outcomes within a
particular organization
• May not be generalizable beyond the
organization
![Page 51: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/51.jpg)
Non-Research
Community Standard/Clinician Experience
![Page 52: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/52.jpg)
Evidence Appraisal
Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC
Perioperative Nursing Specialist, AORN
![Page 53: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/53.jpg)
AORN Appraisal Tools
Research Non-Research
![Page 54: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/54.jpg)
AORN Appraisal ToolsResearch
The strength of the
research evidence is
indicated by I, II, or III
![Page 55: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/55.jpg)
AORN Appraisal Tools
Research
The quality of the
research evidence is
indicated by A, B, or C
![Page 56: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/56.jpg)
AORN Appraisal Tools
Research
The final Research
appraisal score is a
combination of I, II, or III
and A, B, or C
![Page 57: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/57.jpg)
AORN Appraisal Tools
Non-Research
The strength of the non-
research evidence is
indicated by IV or V
![Page 58: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/58.jpg)
AORN Appraisal Tools
Non-Research
The quality of the non-
research evidence is
indicated by A, B, or C
![Page 59: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/59.jpg)
AORN Appraisal Tools
Non-Research
The final Non-Research
appraisal score is a
combination of IV or V
and A, B, or C
![Page 60: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/60.jpg)
Appraisal Score
![Page 61: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/61.jpg)
Evidence Rating
Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC
Perioperative Nursing Specialist, AORN
![Page 62: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/62.jpg)
AORN Evidence Rating Model
Appraisal ScoreEvidence Rating Evidence Requirements
Research Non-Research
IA IVA Regulatory
1: Strong Evidence1: Regulatory requirement
Interventions or activities for which effectiveness has been demonstrated by strong evidence from rigorously-designed studies, meta-analyses, or systematic reviews, rigorously-developed clinical practice guidelines, or regulatory requirements. Evidence from a meta-analysis or systematic review of research studies that
incorporated evidence appraisal and synthesis of the evidence in the analysis.
Supportive evidence from a single well-conducted randomized controlled trial.
Guidelines that are developed by a panel of experts, that derive from an explicit literature search methodology, and include evidence appraisal and synthesis of the evidence.
IBIIA, IIBIIIA, IIIB
IVBVA, VB
2: Moderate Evidence
Interventions or activities for which the evidence is less well established than for those listed under “1: Strong Evidence.” Supportive evidence from a well-conducted research study. Guidelines developed by a panel of experts which are primarily based on the
evidence but not supported by evidence appraisal and synthesis of the evidence.
Non-research evidence with consistent results and fairly definitive conclusions.
ICIICIIIC
IVCVC
3: Limited Evidence
Interventions or activities for which there are currently insufficient evidence or evidence of inadequate quality. Supportive evidence from a poorly conducted research study. Evidence from non-experimental studies with high potential for bias. Guidelines developed largely by consensus or expert opinion. Non-research evidence with insufficient evidence or inconsistent results. Conflicting evidence, but where the preponderance of the evidence supports
the recommendation.
No requirement No requirement 4: Benefits Balanced With HarmsSelected interventions or activities for which the AORN Recommended Practices Advisory Board (RPAB) is of the opinion that the desirable effects of following this recommendation outweigh the harms.
No requirement No requirement 5: No EvidenceInterventions or activities for which no supportive evidence was found during the literature search completed for the recommendation. Consensus opinion.
![Page 63: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/63.jpg)
AORN Evidence Rating Model
1: Strong Evidence
1: Regulatory requirement
IA IVA Regulatory
1: Strong Evidence1: Regulatory requirement
Interventions or activities for which effectiveness has been demonstrated by strong evidence from rigorously-designed studies, meta-analyses, or systematic reviews, rigorously-developed clinical practice guidelines, or regulatory requirements. Evidence from a meta-analysis or systematic review of research studies
that incorporated evidence appraisal and synthesis of the evidence in the analysis.
Supportive evidence from a single well-conducted randomized controlled trial.
Guidelines that are developed by a panel of experts, that derive from an explicit literature search methodology, and include evidence appraisal and synthesis of the evidence.
![Page 64: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/64.jpg)
AORN Evidence Rating Model
2: Moderate Evidence
3: Limited Evidence
IBIIA, IIBIIIA, IIIB
IVBVA, VB
2: Moderate Evidence
Interventions or activities for which the evidence is less well established than for those listed under “1: Strong Evidence.” Supportive evidence from a well-conducted research study. Guidelines developed by a panel of experts which are primarily based on
the evidence but not supported by evidence appraisal and synthesis of the evidence.
Non-research evidence with consistent results and fairly definitive conclusions.
ICIICIIIC
IVCVC
3: Limited Evidence
Interventions or activities for which there are currently insufficient evidence or evidence of inadequate quality. Supportive evidence from a poorly conducted research study. Evidence from non-experimental studies with high potential for bias. Guidelines developed largely by consensus or expert opinion. Non-research evidence with insufficient evidence or inconsistent results. Conflicting evidence, but where the preponderance of the evidence
supports the recommendation.
![Page 65: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/65.jpg)
AORN Evidence Rating Model
4: Benefits Balanced with Harms
No requirement No requirement 4: Benefits Balanced With HarmsSelected interventions or activities for which the AORN Recommended Practices Advisory Board (RPAB) is of the opinion that the desirable effects of following this recommendation outweigh the harms.
V.c. Sterile supplies should be opened for only
one patient at a time in the OR or other
procedure room. [4: Benefits Balanced with Harms]
![Page 66: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/66.jpg)
AORN Evidence Rating Model
4: Benefits Balanced with Harms
5: No Evidence
No requirement No requirement 4: Benefits Balanced With HarmsSelected interventions or activities for which the AORN Recommended Practices Advisory Board (RPAB) is of the opinion that the desirable effects of following this recommendation outweigh the harms.
No requirement No requirement 5: No EvidenceInterventions or activities for which no supportive evidence was found during the literature search completed for the recommendation. Consensus opinion.
![Page 67: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/67.jpg)
Evidence Rating
[3: Limited Evidence]
![Page 68: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/68.jpg)
Appraisal Score
![Page 69: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/69.jpg)
Evidence Rating
[3: Limited Evidence]
![Page 70: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/70.jpg)
Meeting National Guidelines
Clearinghouse Criteria
Lisa Spruce, DNP, RN, ACNS, ACNP, ANP, CNOR
Director of Evidence-Based Practice, AORN
![Page 71: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/71.jpg)
Meeting NGC Criteria
• Documentation will need to be provided
showing that the guideline is based upon
a systematic review of the evidence.
• Documentation must contain
an assessment of the benefits and
harms of the recommended care and
alternative care options.
![Page 72: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/72.jpg)
Anatomy of an AORN
Recommended Practice
Lisa Spruce, DNP, RN, ACNS, ACNP, ANP, CNOR
Director of Evidence-Based Practice, AORN
![Page 73: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/73.jpg)
AORN Evidence Rated RPRecommendation Number: IV
Recommendation
Rationale
Intervention Letter: IV.a.
Intervention
Supporting Evidence
Activity Number: IV.a.1.
Activity
Evidence Rating
Appraisal Scores
![Page 74: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/74.jpg)
AORN Evidence Rated RP
![Page 75: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/75.jpg)
AORN Evidence Rated RP
![Page 76: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/76.jpg)
AORN
Evidence
Rated RP
![Page 77: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/77.jpg)
Questions and Answers
![Page 78: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/78.jpg)
References
1. Goodman, K. (2002). Ethics and Evidence-based Medicine. Cambridge University Press.
2. Crofton, J. (2006). The MRC randomized trial of streptomycin and its legacy: A view from the clinical front line. Journal of the Royal Society of Medicine, 99(10), 531-534.
3. Archie Cochrane: The name behind the cochrane collaboration, cochrane.org/about-us/history/archie-cochrane.
4. Claridge, J. A. &Fabian, T. C. (2005). History and development of evidence-based medicine. World Journal of Surgery, 29(5), 547-543.
5. DiCensor A, Cullum N & Ciliska D (1998) Implementing evidence-based nursing: some misconceptions. Evidence Based Nursing, 38–40.
6. Crawford, C. L. & Johnson, J. A. (2012). To aspirate or not: An integrative review of the literature. Nursing, 20-25.
7. Recommended practices for sterile technique. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2012:e62-e90.
8. Dearholt S, Dang D. Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines. 2nd ed. 2012.
9. OR NurseLink-A perioperative community. AORN. http://www.ornurselink.org/Pages/home.aspx
![Page 79: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/79.jpg)
You must complete the Learner Evaluation online
to earn the 1.0 nursing contact hour.
Registered for this webinar?
Complete the evaluation by using the link in your purchase confirmation e-mail or
by visiting the AORN website:
o Visit www.aorn.org and login using your AORN Web Login.
o Navigate to My AORN and select “Manage Your Education”.
o Earn your Contact Hour by selecting and completing the appropriate webinar
evaluation.
Once you have submitted your evaluation, you can print your certificate
immediately, or you can visit MY AORN > View All Contact Hours > select the
session > click Print Your Certificate at any time.
Contact Hours
![Page 80: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/80.jpg)
You must complete the Learner Evaluation online
to earn the 1.0 nursing contact hour.
Not Registered for this Webinar?
Follow the below instructions to obtain access to the evaluation:– Visit www.aorn.org and login using your AORN Web Login.
– Go to the Product Catalog > Search by name of the webinar or other key word >Select the webinar you just attended that has ‘EVAL’ under it.
– Follow the shopping cart instructions to complete your transaction.
– You will then receive an e-mail containing a link to the online evaluation.
– You may complete the evaluation by using the link in the purchase confirmation e-mail or by visiting the AORN website: www.aorn.org > Navigate to My AORN > select “Manage Your Education”.
Once you have submitted your evaluation, you can print your certificate immediately, or you can visit MY AORN > View All Contact Hours > select the session > click Print Your Certificate at any time.
If you have any questions or require assistance, please contact AORN Customer Service at (800) 755-2676 or [email protected].
Contact Hours
![Page 81: Anatomy of the New Evidence-Rated AORN Recommended Practices](https://reader031.vdocument.in/reader031/viewer/2022013108/554af50cb4c905852a8b59fd/html5/thumbnails/81.jpg)
Perioperative Standards and Recommended PracticesThis comprehensive publication provides the evidence-based recommended practices for both patient
and worker safety in all settings where operative and other invasive procedures are performed.
New evidence-rated recommended practices include: • Pneumatic Tourniquet-assisted Procedures
• Environmental Cleaning
• Packaging Systems for Sterilization
• Sharps Safety
Updated from 2013 edition:
• Prevention of Transmissible Infections
• Safe Environment of Care
• Sterile Technique
• Sterilization
Get Your 2014 Edition Today
www.aorn.org/RecommendedPractices