By Kelly Teal
Every year, the Association of periOperative Registered Nurses (AORN) releases the latest version of its Guidelines for Perioperative Practice to its 41,000 members. Each edition of the book features updated instruction on practices that help perioperative nurses and, in turn, infection preventionists, ensure patient health and safety. For example, the 2017 publication contains detailed new insight into hand hygiene in the surgical suite. The information discusses how fingernails, and even polish, can harbor germs, and offers best practices for preventing contamination that could hurt the patient. Through the teaching efforts of AORN members, and the acceptance of the U.S. Agency for Healthcare Research and Quality National Guideline Clearinghouse, these directions will reach more than 2,500 hospitals and more than 160,000 RNs.
But just how does such widely embraced instruction come to life? The process is onerous and time-consuming. Indeed, the entire experience of crafting a new AORN guideline “is like giving birth to a child,” says Amber Wood, MSN, RN, CNOR, CIC, FAPIC, senior perioperative practice specialist for AORN. “The guidelines each take nine months to a year from concept to publication,” she said. “At the end, we are very proud to show the world what we’ve created, in hopes of improving patient outcomes and the safety of perioperative team members.”
The Making of a Guideline
For more than 40 years, AORN has equipped perioperative nurses and other healthcare professionals with the knowledge needed to pro-mote what it calls “optimal outcomes” for patients in the OR. Thus, the organization has its guideline-developing methodology down pat.
A guideline starts out as an idea that is subjected to a thorough investigation before becoming official.
Anyone may bring a specific piece of evidence to the attention of the Guideline writing team but only AORN members may submit a proposal, says Ramona Conner, MSN, RN, CNOR, editor-in-chief of AORN’s Guidelines for Perioperative Practice.
That inquiry goes to Conner. She reviews it and asks any necessary follow-up questions before forwarding it to AORN’s Guidelines Advisory Board (GAB). Board members “play a vital role in guiding the profession of perioperative nursing by facilitating review and approval of the Guidelines,” Conner said. As such, they must set themselves apart as top-notch experts.
The GAB is comprised of a chairperson, at least eight perioperative nurse members and liaisons from other professional associations such as the American Association of Nurse Anesthetists, the American College of Surgeons, the Association for Professionals in Infection Control and Epidemiology, and more. All GAB members must hold a degree in nursing or a related field and AORN prefers that they have a master’s. AORN’s president-elect appoints the members; they serve for one year and can be re-appointed. The GAB liaisons are determined by the organizations they represent.
Proposed guideline in hand, the board then evaluates it to see if it:
• Supports the mission of the organization;
• Has a significant impact on perioperative nursing practice;
• Applies to all areas where operative and other invasive surgical procedures may be performed;
• Is not addressed in another AORN document;
• Addresses conflict in or confusion regarding optimal level of practice;
• Includes published research or non-research evidence related to the topic; and
• Addresses new/emerging technology or a gap in perioperative nursing practice guidance.
Upon finishing that evaluation, the GAB takes one of the following steps: It accepts the proposal and tells Conner to schedule a new work item, and initiate the development process; it forwards the item to a different committee or department for consideration; it incorporates the proposal into an existing guideline; or it rejects the proposal.
If AORN decides to move forward with a new guideline, the deep dive into its merit begins.
First up, a medical librarian conducts an extensive literature search. This investigation of multiple databases will unveil the extent to which the topic has undergone examination or received attention.
Then, the lead author, a nurse in AORN’s nursing department, analyzes the strength and quality of gathered data using the appropriate AORN Evidence Appraisal Tool. The author determines what evidence to include or not, Conner said. The result is a set of recommendations that undergoes assessment in areas including regulatory requirements and whether the benefits of implementation outweigh any harms.
Next, that document goes out for a 30-day public comment period. Anyone may chime in on the matter, Conner says.
After the public comment period closes, the guideline’s final draft is sent to the GAB for review and approval. This step provides yet one more check for accuracy and relevance.
Finally, with the board’s sign-off, a guideline is published, and distributed digitally and in print.
Each AORN guideline receives a review and update every five years. That stringent attention is why AORN’s guidelines are accepted by the U.S. Agency for Healthcare Research and Quality National Guideline Clearinghouse, and are nationally recognized principles for perioperative practice.