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New AORN Guideline on Team Communication
KEY TO COMMUNICATION The 2018 guide includes a new guideline on effective communication between perioperative team members.

The first evidence-based guideline for effective communication in the perioperative environment highlights AORN's 2018 Guidelines for Perioperative Practice. The collection of 32 guidelines, published each January, also includes updates to 5 established guidelines.

The new guideline for team communication covers key opportunities for communication throughout a patient's continuum of surgical care, such as briefings, surgical pauses and hand-overs. Evidence-based guidance also addresses opportunities to strengthen team communication, such as through simulation training.

"Every AORN guideline recommends team involvement and shared communication with all stakeholders on the perioperative team, yet research still identifies ineffective team communication as a common cause of adverse events," says Ramona Conner, MSN, RN, CNOR, editor-in-chief of AORN's Guidelines for Perioperative Practice. The new guideline expands upon and supersedes the Guideline on Transfer of Patient Care Information.

The Guideline for Positioning the Patient has been updated to include a new recommendation addressing neurophysiological monitoring used during surgery to detect positioning injuries in real time. Updates to the Guideline for Medication Safety include recommendations on handling hazardous medications such as antineoplastic drugs.

The remaining 3 updates involve name changes along with new recommendations. The guidelines for Medical Device and Product Evaluation cite new evidence showing the importance of involving the RN in the evaluation of medical products. The guidelines for Manual Chemical High-Level Disinfection discuss the ineffectiveness of some HLDs against pathogens such as HPV. And the updates to the Prevention of VTE explore many of the risk factors that should be assessed preoperatively.

"AORN is dedicated to making sense of this wealth of evidence by exploring the literature, rating the evidence, and shaping practice recommendations that perioperative practitioners can easily apply in their unique practice settings," says Ms. Conner.

JoEllen McBride, PhD

Experimental Surgery Treats Erectile Dysfunction
TREAT ED IN THE OR? Half of men over the age of 40 suffer from ED, according to the American Urological Association.

Men who suffer from erectile dysfunction (ED) might soon be able to undergo an experimental nerve transfer procedure that promises to reenergizes their sex life and turn outpatient facilities on to new business opportunities.

Reconstructive plastic surgeons Eric Wimmers, MD, and Andrew Elkwood, MD, FACS, performed what's believed to be the first procedure of its kind on a police officer who was struck by a drunk driver while arresting another person for driving under the influence. The officer's hip fractures and severe pelvic trauma damaged the cavernous nerve, which creates an erection.

The procedure involves grafting the genitofemoral nerve, which causes the scrotum to tighten and pull up, to the cavernous nerve. Drs. Wimmers and Elkwood isolated the genitofemoral nerve, confirmed its location with intraoperative electromyography and rotated it about 3 cm through a subcutaneous tunnel to the cavernous nerve. Although the procedure is considered groundbreaking, Dr. Wimmers says there's nothing new about its technical aspects.

The patient, who went home the day of surgery, is recovering nicely, says Dr. Wimmers. He says the patient claims the procedure has caused less discomfort — he was off pain medications a week after surgery — than the pelvic reconstructive procedures he has endured.

Dr. Wimmers expects the transferred genitofemoral nerve to grow into the recipient site at the cavernous nerve between 3 and 6 months post-op, at which time the patient can attempt to have sex again. He says the minimally invasive surgery is suited for the outpatient setting and has the potential to treat ED caused by prostate cancer, prostatectomy surgery, radiation treatment of prostate cancer and diabetes.

"The floodgates will open once we demonstrate positive results," says Dr. Wimmers. "There are millions of men with this problem."

Daniel Cook

Suit: Insurer Reimbursed Patients, Not Hospital Says Insurance Co. Failed to Reimburse Them $400k
REIMBURSED St. Charles Surgical Hospital says Blue Cross/Blue Shield owes them after failing to reimburse them for multiple patients' procedures.

A surgical hospital that specializes in breast reconstruction is suing Blue Cross/Blue Shield of Louisiana for breach of contract, claiming the insurer reimbursed patients and not the hospital more than $400,000, court records show.

St. Charles Surgical Hospital in New Orleans, La., filed the suit last month, claiming Blue Cross/Blue Shield paid out $411,761.40 to several patients — reimbursements to which the hospital says it was entitled.

The hospital is requesting that the insurance provider pay for damages sustained by the error as well as court costs and attorney fees.

Neither Blue Cross/Blue Shield of Louisiana, nor James Williams, an attorney representing the hospital, responded to requests for comment.

St. Charles Surgical Hospital specializes in reconstructive breast surgery for women facing breast cancer and has been recognized by the American College of Surgeons as one of 37 hospitals participating in the ACS's National Surgical Quality Improvement Program (NSQIP).

Anna Merriman

InstaPoll: Your Greatest Staffing Challenge?
Tell us in this week's InstaPoll what's most challenging when it comes to surgical nurses — recruiting them, training them or retaining them.

Most (58%) of the 324 respondents to last week's poll attend 1 or 2 surgical conferences per year. Nearly one-fourth (24%) don't attend any. The results:

Has how many surgical conferences will you attend in 2018?

  • 0 24%
  • 1 31%
  • 2 27%
  • 3 11%
  • 4 or more 7%

Dan O'Connor

News & Notes
  • Robotic platform approved for entry via surgeon-made incisionsSurgeons can now use the Medrobotics' robotic platform in more minimally invasive procedures thanks to an FDA sign-off. Approval previously only covered entry through natural orifices. Now, the flexible robotic scope can be used in procedures that involve transabdominal and transthoracic entry. With this latest approval, the Raynham, Mass., based company is looking to expand the device's use to other surgeries such as transvaginal gynecologic procedures.
  • Orthopedic center blames Allscripts after cyber attack Allscripts Healthcare Solutions did not do enough to protect itself against a massive ransomware attack on Jan. 18, according to one of Allscripts's clients, Surfside Non-Surgical Orthopedics in Boynton Beach, Fla. The orthopedic center sued Allscripts, which provides technology for electronic health records for more than 180,000 physician users, claiming they were unable to access patient records and prescribe medication as a result of the attack, says the lawsuit.
  • Rhode Island bill proposes requiring certification from techs A bill proposed by the Rhode Island General Assembly, RI S2076, would require first-time reprocessing technicians who are hired after December 2018 to pass a nationally accredited exam for central service technicians. Anyone qualified to work as a technician in an ASC would also have to complete 10 hours of continuing education yearly in order to remain qualified.