New book gives guidelines for the outpatient setting

Why do outpatient surgery patients have to undress completely for all procedures? What is the best way to reduce anxiety without overmedicating so the patient will recover sooner?

These are only two of many questions asked by Denver-based Association of Operating Room Nurses (AORN) members who have been trying to adapt AORN-recommended practices and principles to the ambulatory surgery setting, says Denise L. Geuder, RN, MS, CNOR, vice president of St. Francis Hospital in Tulsa, OK, and chair-elect of AORN’s Ambulatory Surgery Specialty Assembly.

Because its members have moved into nontraditional settings, AORN has targeted a version of its annual publication of Standards, Recommended Practices & Guidelines to ambulatory surgery program managers and nurses.

In addition to moving from inpatient to outpatient surgery settings, AORN members have moved from hospital-based ambulatory surgery programs to freestanding centers and to physician office-based surgery settings, says Geuder.

Streamlining the new version

"Ambulatory Surgery Principles and Practices recommends practices that are adaptations of the AORN Standards. The adaptations take into account the different physical and staffing resources within an ambulatory surgery program," she says. "They are more streamlined because we’ve pulled out sections, such as critical care, that aren’t applicable to ambulatory surgery."

Chapters in the ambulatory surgery publication cover:

    • standards and recommended practices that apply specifically to ambulatory surgery;

    • patient care including preoperative care, conscious sedation, postoperative care, and pain management;

    • practice issues such as materials management, competency, quality measurement, medical records, and risk management;

    • business and regulatory issues such as business concepts, human resources, emergency preparedness, accreditation, and regulation;

    • special considerations such as office-based surgery, endoscopy labs, and mobile lithotripsy.

While the ambulatory surgery publication does contain a full range of practices and guidelines, it is also important for surgery program managers to use the publication in combination with the full AORN standards publication, says Geuder. Because the ambulatory publication is streamlined, a surgery program manager may need additional information if her or his surgery program handles some cases not normally handled by ambulatory programs, she explains.

The most important thing a day surgery program manager must do is anticipate what can go wrong in different situations, says Geuder. While ambulatory surgery patients are pre-screened to eliminate emergency situations, problems can occur, she says.

"It is critical for a day surgery program to have emergency equipment such as crash carts available and have staff prepared to handle a crisis during surgery," she says.

"Arrangements for care and transport of the patient must be made by contract with local emergency rooms if you are a freestanding or office-based center, and your staff need to know the procedure to follow," she adds. "This is the type of advice offered in the new publication."