AORN addresses environment and safety

Tissue banking recommended practice enhanced

Reuse of single-use devices, environmental responsibility, and development of a patient safety culture are three of the new or significantly revised guidance statements to be included in the 2006 Standards, Recommended Practices and Guidelines published by the Association of periOperative Registered Nurses (AORN).

The Reuse of Single-Use Devices guidance statement was updated significantly to reflect new Food and Drug Administration (FDA) requirements, including quality system regulations, says Ramona L. Conner, RN, MSN, CNOR, perioperative nursing specialist in the Center for Nursing Practice at AORN in Denver. "The statement addresses management, purchasing, documentation, and control of the process."

A beneficial portion of the guidance statement is a table that provides a cross-reference to relevant FDA regulations that apply to reuse of single-use devices, says Conner. (See table 1.) "This table is very handy for people who are struggling to stay on top of regulatory changes and requirements," she explains. This table also is helpful for outpatient surgery managers as a guide to questions to ask of their reprocessor, Conner adds.

Reuse of single use devices also ties into a new guidance statement that addresses environmental responsibility, says Jane Kusler-Jensen, RN, MBA, CNOR, director of surgical services for Aurora BayCare Medical Center in Green Bay, WI. "The main concern is that we maintain the same quality when we reprocess; but if we can reprocess an arthroscopic shaver without compromising quality and use it five times instead of only once, we’ve cut down on the number of shavers in the waste," she explains.

AORN has had a recommended practice for environmental responsibility, but it was seldom referred to and it did not provide a great deal of guidance, reports Conner. "We have added new information and upgraded the recommended practice to a guidance statement that does offer advice on how a surgery manager can create a green environment within his or her program." The guidance statement addresses the elimination of mercury, managing hazardous waste, disposal of chemicals, and recycling, she points out.

"There is so much information available for outpatient surgery managers about every aspect of environmental responsibility that we have also included web sites that have additional information," says Conner. "We have even found resources that focus on the environmentally conscious design and construction of health care facilities."

Safe disposal of hazardous waste is one environmental responsibility that all outpatient surgery program staffs face, and it often can be a costly task, says Ann Geier, RN, MS, CNOR, CASC, vice president of operation for Ambulatory Surgical Centers of America in Norwell, MA. "I believe that everyone went overboard by red-bagging all waste, but now we look carefully at what is hazardous waste and what is regular trash," she says. It is too costly for centers to throw noncontaminated trash into red bags because most trash removal companies charge by the weight or the number of containers, she explains.

Avoid retribution for staff who report errors

Another new guidance statement calls for the development of a patient safety culture throughout the perioperative process, says Conner.

"It is in everyone’s best interest to encourage staff members to report errors and near misses so that process changes can be implemented to prevent errors in the future," Conner says. A true patient safety culture that enables staff members to discuss close calls when there is no adverse outcome can be attained only if there is no fear of retribution, she points out.

Kusler-Jensen suggests, "You have to look at the situation — not the person — when there is an error. There will always be a chance for human error, but if you standardize your processes and have backup safety measures built into the processes, you reduce the opportunity for human error to harm the patient."

If there is a close call or an adverse outcome, look first at the process to see where the breakdown occurred, Kusler-Jensen recommends. If staff members understand that they can report near misses without automatically being accused of causing the error, then you will have a chance to learn about potential problems before they occur, she says. "We put the best processes into place that we can, but we will always encounter situations that we might not have considered," Kusler-Jensen says. "A patient safety culture gives everyone permission to point out what might need to be evaluated."

Tissue banking to reflect regs, standards

In addition to these new guidance statements, AORN’s 2006 Standards and Practices also will include a significantly updated recommended practice for tissue banking, says Conner. New FDA regulations, as well as accreditation standards for organizations accredited by the Joint Commission for the Accreditation of Healthcare Organizations, were effective in 2005, and the recommended practice reflects the more stringent requirements of these two organizations, she explains. The recommended practice addresses the specific requirements for storage of tissue, but the biggest change is related to documentation and tracking of the tissue, she says.

Kusler-Jensen says, "I believe that we have a good tracking system in place, but we will need to fine-tune it to make sure that we are recording maintenance of temperature throughout the whole process of receiving tissue. Everyone’s concern is what happened during the shipping process, she says. For example, does it come to you by FedEx? How long did it sit on a loading dock? Was the proper temperature maintained throughout the time it left the tissue bank and arrived at your facility? "These are all questions that your documentation should address to ensure that the tissue is safe for your patient," Kusler-Jensen says.


For more information on changes to guidance statements and recommended practices of the Association of periOperative Nurses Association, contact:

  • Ramona L. Conner, RN, MSN, CNOR, Perioperative Nursing Specialist, Center for Nursing Practice, Association of periOperative Nurses Association, 2170 S. Parker Road, Suite 300, Denver, CO 80231. Telephone: (800) 755-2676 or (303) 755-6304. E-mail:
  • Ann Geier, RN, MS, CNOR, CASC, Vice President of Operations, Ambulatory Surgical Centers of America, 22 Frogmore Road, Mount Pleasant, SC 29464-6651. Telephone: (843) 216-2432. E-mail:
  • Jane Kusler-Jensen, RN, MBA, CNOR, Director, Surgical Services, Aurora BayCare Medical Center, 2845 Greenbrier Road, Green Bay, WI 54311-6519. Telephone: (866) 227-9620 or (920) 288-8000, ext. 4808. E-mail:
  • For more information about developing an environmentally-friendly operating room, go to This web site offers tips on how health care organizations can better handle waste disposal, elimination of mercury, disposal of chemicals, and construction for more efficiency.
  • To order a copy of the 2006 Standards, Recommended Practices and Guidelines, go to Choose "products" on top navigational bar, then click on "2006 Standards" under the "Feature of the Month" section. Cost is $55 for members and $69 for nonmembers, plus $7 for shipping.