The ACORN Standards and Their Implementation

Discuss about the Perioperative nursing management of posthumous organ.

The current assignment focuses upon the legal and professional standards of nursing. The standards of nursing which had been taken into consideration over here is the Australian College of Perioperative Nurses Standards (ACORN).  The standards have been implemented to ensure optimal patient safety in a surgical setup. The aim for the implementation of the standard is to remove all items used during surgery and procedures from the proximity of the patient unless intentionally retained. The principle guidelines of the ACORN standards are aimed at retrieval of all items used during surgery. The instruments used should be accounted for and properly documented. The ACORN standards are underpinned by description of various roles such as circulating nurse, recovery nurse, instrument nurse and anaesthetic nurse.

The minimum number of nurses required depends upon the complexity of the process and the requirements of the patient. Some of the basic objectives of the ACORN standards are – safety of the staff and patient, asepsis and clinical care, management and staffing, prevention of infection. In the current assignment, the relevance of the ACORN standard within a preoperative nursing scenario has been discussed. The practices adopted within an actual scenario have been evaluated in accordance with the ACORN standards.

The implementation of the ACORN standards helps in ensuring that the patient safety is maintained during the conduct of the surgical process and an instrument in not retained in the body cavity of the patient by mistake. It could be done by following step wise checks which ensures that the instruments are safely removed before a body cavity is closed.

For understanding the importance of the ACORN standards in an actual clinical set up it is necessary to reflect upon an actual scenario. Here, the patient who was a 58 year old man was admitted to the hospital for ANTERIOR SPINAL FUSION. The case was started at 10 am and finished at 5 pm. The count was performed by the same scrub and count nurse. However, during the conduct of the operative procedures the nurses failed to comply with the accountability standards of instrument handling. It was later found during one of the post –operative diagnosis stage that a Raytec sponge was placed on top of lung during the surgical process. The   position of the Raytec was detected through post-operative X-ray.

It could be related to the statement number 5 of the ACORN standards, which states that all the absorbent accountable items used during the surgery should be handled in manner, which will reduce the risk of the items being retained inside the body cavity of the patient (Gore and Osborne 2017, p.56). On further analysis, it was found that the nurse failed to notify the doctor that the count has not been finished. Additionally, the hospital staffs lacked effective training and guidance upon the use of the ACORN standards for ensuring that accountability is maintained for the handling and management of instruments within a preoperative care unit. As per the standard statement 3 of the ACRORN policy and guidelines, safe counting techniques need to be followed by the nurse. In the current scenario by not providing the doctor the required information there was a clear breach of ACORN standard 8.  Under the safe counting techniques, the nurse was required to keep an account of the actual instruments and items used during the surgical process (Lynn and Brownie 2015, p.112).  This could further help in reducing the chances of error within a perioperative care environment.

The Relevance of ACORN Standards in Preoperative Nursing Scenario

The issue discussed with regards to an actual medical scenario can be further evaluated based upon the ACORN standards.  The ACORN standards can be divided into a number of sub standards from standard statement 1 through 9. The relevance of the standards with regards to the current healthcare scenario could be discussed over here. The standard statement 1 contains policies and guidelines surrounding the management of items during surgery.   As commented by Hains  et al. (2016), failure to comply with the standard can result in  incidence of medical negligence. The second statement states the nurses attending to the care concerns of the patient within the perioperative environment needs to bear the responsibility for the management of the surgical instruments (Irelandand Osborne 2016, p.54). As per the directive when there is one instrument and one circulating nurse one approved perioperative documentation (APD) should be used. However, if there is more than one circulating nurse, separate APD should be used by each circulating nurse. This helps in compliance checking and monitoring in critical care. The proximity of the surgical sites makes it difficult to ensure the separation of the accountable items by the two teams (Duff et al. 2016, p.24). One of the most important criteria is the safe counting technique,   which is complied in order to ensure that the surgical equipments and instruments are not retained inside the body of the patient. In this respect, the nurses need to ensure that the items remain intact in their inner packaging so that they are not separated before counting (Hains et al. 2016, p.550). Additionally, it is the duty of the instrument nurse to ensure that the contaminated surgical items are duly separated from the patient as contact with the contaminated articles can initiate secondary infection within the patients. As per the standards 4, when a body cavity is entered during the surgical process an additional count needs to be performed (Duff et al. 2016, p.24).

In the current scenario 200 raytec and 100 surgical sponges were used. During the 1st count one raytec was left on top of the lungs. Due to the presence of a large number of accountable items, the nurse failed to finish the count before closing the wound. Here, the nurse also failed to finish the count before the removal of the endotracheal tube (ETT)   or extubation.  Therefore, the patient had to be re-extubated and the wound site opened to take the raytec out. Therefore, effective counting procedures techniques along with lack of communication resulted in the situation of medical negligence (Ireland and Osborne 2016, p.54). As per the standard 6, standardised trays were required to be maintained. The tray list would further help in maintaining a safe count of the instruments. According to statement 7 of the of the ACORN framework, the nursing professional needs to conduct a progressive count before removing the instruments from the actual clinical setup. Under this the scrub nurse needs to ensure that the instrument bags are retained in the surgical room until the final count is completed (Jensen and Shipp 2015, p.10). However as argued by Gore and Osborne (2017), it is difficult to keep track of the small articles and items such as surgical sponges and swabs which can also be a cause of secondary inflammatory reactions.

Evaluation of an Actual Healthcare Scenario Based on ACORN Standards

Therefore, compliance with the ACORN standards can help in ensuring the safety standards are maintained within a clinical setup. Thus, reflecting upon the current case study it could be said that there was violation on the part of the scrub nurse to follow the standard 8 statement mentioned in the ACORN.  In this case, there was an error   on the part of the scrub nurse to follow the process effectively. The raytec left to the development of further secondary infection in the patient.  As per the sub-directive of the statement 8 of the ACORN standards, extreme emergency situations may prevent normal counting and documenting process form being followed (acorn.org 2018). However, there was a violation on the part of the scrub and count nurse, where the nurse had used the item for local dressing and later on forgot to remove it. On further diagnosis, it was found that there was also a lack of clear instructions to the nurse regarding the methodology to be followed on the operation table. Hence, it was required that a clear working policy be implemented within the perioperative care. Additionally, providing sufficient training over the ACORN standards can also help in complying with the safe policy and measures (Guglielmi et al. 2015, p.360). As per the standard 4 of the ACORN guidelines, once a surgical gauge or something of that order enters the body cavity of the patient during the surgical process, effective care should be taken to remove them duly. This is because retaining of such surgical instruments can elicit defence reaction in the immunocompressed patient (White and Spruce 2015, p.52).

The ACORN standards were developed in order to safeguard the professional interests of the perioperative nurses (Oriel and Itani 2016, p.640). They provide a minimum standard of care for the perioperative nurses. Some of the objectives which had been promoted though the implementation of the standards are infection prevention and adherence to the 2016-2017 ACORN standards.  As commented by Matikainen (2017), the implementation of the guideline can help in controlling or reducing the risk of exposure to infectious agents. Therefore, the policies and procedures are developed aligned to the recommendations set by the Australian Commission on safety and quality.  The figures and stats have mentioned that 11% of the healthcare cost in Australia generate due to medical negligence (aihw.gov 2018). Hence, implementation of the ACORN standards would ensure that the additional healthcare costs could be diverted towards the development of an effective and better integrated healthcare structure. As commented by Jensen and Shipp (2015), the ACORN staffing systems and procedures varies from hospitals to hospitals. Therefore, the education and skill sets possessed by the nurses play a critical role in ensuring the quality of care. In this respect, the current healthcare set up also failed to employ implement effective training programs for educating the nurses regarding the different aspects of perioperative care and management.

Therefore, for the management of the current issue within preoperative environment evidence based practices needs to be developed. Some of the evidence based practices which could be implemented over here are use of protective gloves which can further control the rate of infection within the perioperaitve environment. The ACORN standards of care were divided into two sub themes, which are the maintenance of standards of care, the enhancement of the care standards.  As mentioned by Battie (2016), it was required to set up a resource body that will support the registered nurses and advice them on the minimum standards which needs to be followed. The second objective was to develop the effective policies and guidelines based upon the real and actual scenario (Ross et al. 2017, p.90).  The development of a resource team was an instrumental step forward as it would help the nurses in following the necessary standards of perioperative care.

The Importance of Safe Counting Techniques and Standardization of Trays

Additionally, the development of guidelines based upon the current scenario can help the scrub and the count nurses understand the loopholes in their services.  However as supported by Osborne (2017), awareness and sufficient support from the healthcare committee is required for the implementation of the evidence based practices.

The ACORN standards could be further discussed with reference to the case scenario.  Here, the standards 4 and 8 were violated where the nurse failed to follow the surety protocols with the patient and left the raytec over the lungs, which led to the development of secondary infection. The standard 4 states, that before stitching the body part of the patient after surgery, care needs to be taken that the surgical items and equipments have been duly removed.

In order   to ensure that effective nursing standards are maintained within the perioperative care a number of additional quality control checks and measures needs to be implemented. For example implementation of evidence based practices within the nursing care, which would help in reducing the chances of accidents. Additionally, knowledge of the ACORN standards would also help in preventing legal breaches. It has been seen that on an average 5% hospitals in Australia fail to follow the legal and professional nursing standards resulting in legal implications on the part of the hospices (Jensen and Shipp 2015, p.10). The legal violations results in monetary implications which results in unnecessary cost cutting.

Additionally, reflecting upon the actual clinical scenario we have found that the hospital nurses lacked knowledge regarding the ACORN standards. Therefore, the lack of knowledge affected the quality of the care services delivered by the registered nurses.  Hence, implementing the effective policies and guidelines as a part of the care regimen of the hospital can help in controlling the rate of negligence. Some of these could be made available to the nurses in the form of handouts and maintained in the form of directives in the operational wards. This would help in ensuring that the nurses do not miss out on the important steps and procedures to be followed.

Training and exposure to practical in-house sessions also forms a compulsory part of the care scenario. As commented by Duff  et al. (2016), the statetement 8 of the ACORN standards further  instructs that in case a normal count cannot be followed, post-operative x-ray of the surgical site needs to be conducted.  As commented by Gao  et al. (2017), the   provision of training can improve the quality of care and support services. The training could be given as a compulsory part of the care plan. Additionally, based upon the training the employees could be awarded with special incentives, which could motivate them further in improving the standards of care. 

Conclusion

The current assignment focuses on the concept of legal and professional issues in nursing. Here, a case study had been taken for reflection where the patient had to undergo immediate surgery. Due to the lack of sufficient knowledge in the per-operative nurses regarding the ACORN standards the infection prevention standards were not taken care of effectively. Therefore, educating the healthcare staff regarding the ACORN standards along with conducting internal checks and random assessment can help in maintaining the quality of care. Additionally, implementation of the evidence based practices further helps in maintaining the standards of care.  Some of these are implementation of a resource team which can help the nurses in understanding the requirements of the emergency care process.

Conclusion

 In the current study the ACORN standards have been discussed with regards to a perioperarive care. Therefore, revision of the policies and the guidelines of the hospital can help in the implementation of acute care. Additionally, designing of effective care plans and strategies based upon immediate situations can further help in improving the quality of care. For the implementation of the ACORN standards more importance needs to be given upon the legal and professional guidelines. The legal and professional guidelines ensure that the policies are implemented in place. Therefore, building of effective legal framework forms the backbone of an effective perioperative care.

References

acorn.org  2018, acorn.org , Available at : https://www.acorn.org.au/standards/ [Accessed on  13 Mar. 2018]

aihw.gov  2018, aihw.gov , Available at : https://www.aihw.gov.au/reports-statistics [Accessed on 12 Mar. 2018]

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