Download evaltool_positioning_allpositions_rn

[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Positioning, All Positions – RN
Name:
Date:
Competency Statement: The perioperative RN has completed facility- or health care organization-required education and competency verification
activities related to positioning patients in the perioperative setting.1
1.
Guideline for positioning the patient in the perioperative practice setting. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2016:649-668.
Outcome Statement: The patient is free from signs and symptoms of injury related to positioning.2
2.
Petersen C, ed. Positioning injury. In: Perioperative Nursing Data Set. 3rd ed. Denver, CO: AORN, Inc; 2011:178-184.
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
1. Assesses the patient for positioning needs related to
a. age;
b. preexisting conditions (eg, neurologic, cardiovascular);
c. perception of pain;
d. allergies (eg, medications, latex, tape);
e. pregnancy status;
f. skin integrity;
g. risk factors for pressure ulcer development;
h. height and weight (eg, body mass index);
i. risk for falls (eg, visual compromise, medications, level of
consciousness);
j. presence of implanted or external devices;
k. laboratory values (eg, clotting factors, bleeding times);
l. presence of jewelry and piercings; and
m. mobility concerns (eg, musculoskeletal compromise, amputee,
contractures).
2. Identifies patient populations with increased risk for integumentary,
respiratory, nerve, or cardiovascular compromise related to positioning
including
a. neonates,
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 1 of 7
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Positioning, All Positions – RN
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
b. elderly,
c. malnourished, and
d. obese.
3. Identifies risk factors that can increase integumentary, respiratory,
nerve, or cardiovascular compromise related to positioning including
patients with a history of
a. chronic disease (eg, diabetes),
b. vascular disease, or
c. pressure ulcer development.
4. Identifies patients at risk for pressure ulcer development related to
patient positioning including patients who are
a. age 70 years or older,
b. scheduled for vascular surgery,
c. scheduled for a surgery greater than 4 hours,
d. are thin or have a low BMI,
e. have a preoperative Braden score less than 20, and
f. have poor nutritional status.
5. Identifies specific positioning concerns for the patient who is
morbidly obese (ie, a BMI greater than 40, or weighs more than 100
lbs over their recommended weight) including
a. respiratory complications (eg, airway compromise, hypoxia,
intra-abdominal pressure on the diaphragm, aspiration) that may
require placing patient in a sitting or lateral position rather than
supine and avoiding Trendelenburg’s position if possible;
b. cardiovascular complications (eg, increased cardiac output,
increased pulmonary artery pressure, inferior vena cava
compression) that may require placing a wedge under right flank
in supine position; and
c. musculoskeletal complications (eg, joint injuries if ankles rotate
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 2 of 7
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Positioning, All Positions – RN
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
outward, legs falling off bed if bed is not wide enough).
6. Selects the correct position and positioning devices for the patient
based on the procedure to be performed, patient assessment factors,
and surgeon’s preference.
7. Selects the correct position and positioning devices for patients at risk
(eg, morbidly obese, thin or malnourished, older adult, pediatric).
8. Verifies that all components of selected bed and positioning devices
are in the OR (eg, padded arm boards, padding overlays, safety restraints) and are clean and in functional condition (eg, operating properly, free of cuts, and tears) before transporting the patient to the OR.
9. Uses positioning devices or equipment correctly for
a. maintaining body position,
b. ensuring proper body alignment,
c. protecting bony prominences, and
d. preventing musculoskeletal and nerve injury.
10. Verifies availability of lateral transfer devices and lift equipment if
needed to provide for safety of patient (eg, preventing pulling or sliding injuries) and perioperative personnel (eg, preventing back injuries).
11. Keeps patient’s body aligned during transfer to and from transport
vehicle.
12. Solicits additional personnel as needed for patient positioning.
13. Provides guidance and mentoring when delegating positioning tasks
to perioperative personnel.
14. Provides for patient privacy and dignity throughout the patient
transfer and positioning process.
15. Provides for patient safety throughout the positioning process by
a. using safety securing devices (eg, bedrails) correctly and in a
timely fashion to prevent falls;
b. verifying that all patient jewelry and body piercing jewelry have
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 3 of 7
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Positioning, All Positions – RN
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
been identified and removed or secured before positioning the
patient;
c. using safe positioning principles to prevent musculoskeletal
injuries;
d. using safe positioning principles to prevent nerve injuries;
e. implementing strategies to redistribute pressure to prevent
pressure ulcer formation; and
f. assessing the patient throughout the transfer and positioning
process and throughout the operative procedure as possible.
16. Uses bed and positioning devices specific for the patient who is
morbidly obese including
a. a procedure bed that is capable of articulating and supporting
patients weighing 800 to 1,000 lbs;
b. a bed that has specialized hydraulics capable of lifting patients
weighing 800 to 1,000 lbs;
c. a mattress that provides sufficient padding and does not “bottom
out”;
d. correctly sized arm boards or padded toboggans;
e. stirrups, if needed, that provide sufficient weight and extremity
support; and
f. extra-long or extra-wide safety straps or two safety straps (eg, one
each over the thighs and lower legs) if needed.
17. Evaluates correct position before drapes are applied by
a. verifying that pressure is evenly distributed over bony
prominences;
b. assessing the patient’s body alignment to prevent musculoskeletal
compromise;
c. assessing placement of safety straps;
d. assessing the patient’s skin integrity and verifying that there is no
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 4 of 7
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Positioning, All Positions – RN
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
18.
19.
20.
21.
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
pooling of solutions or wet surfaces;
e. assessing tissue perfusion; and
f. confirming that the patient’s circulatory, neurological, or
respiratory systems are not compromised.
Re-evaluates and collaborates with surgeon and anesthesia
professional about the need or possibility to reposition patient during
procedures exceeding a designated time per facility or health care
organization policy.
Assesses the patient postoperatively for signs and symptoms of
physical injury related to intraoperative positioning such as
a. skin injuries (eg, redness, bruises, skin tears);
b. musculoskeletal and nerve injuries (eg, aberrations in circulation,
movement, or sensation);
c. eye injuries; and
d. pressure ulcer development (eg, skin blanching, purple
appearance originating at muscle over bony prominences).
Identifies when positioning parameters have not been met or have
been compromised and takes corrective action by
a. notifying the surgical team (eg, surgeon, anesthesia professional,
scrub person, charge RN);
b. assisting surgical team to reposition the patient; and
c. documenting problem and resolution on the intraoperative
nursing record.
Informs postoperative care providers of intraoperative positioning
issues and identifies potential risk factors including
a. physical injury related to intraoperative position, and
b. pressure injury related to intraoperative position.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 5 of 7
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Positioning, All Positions – RN
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
22. Adheres to standard precautions, and other precautions as required,
when cleaning and disinfecting contaminated positioning devices.
23. Verifies patients are transported safely by
a. applying a safety strap;
b. ensuring one team member is at the head of the bed;
c. placing children in neonate transport vehicles or correctly sized
cribs;
d. protecting the patient’s body parts from injury;
e. pushing the transport vehicle feet-first;
f. raising siderails;
g. securing IV lines, bladder catheters, dressings, drains, IV poles;
h. securing oxygen tanks in holders; and
i. using racks to hold monitoring equipment.
24. Inspects positioning devices after use for tears, cuts, and
functionality, and removes broken or damaged equipment from
service according to facility or health care organization policies and
procedures.
25. Completes required documentation related to patient positioning
accurately, completely, and legibly according to the facility or health
care organization policies and procedures including
a. names and titles of persons positioning the patient,
b. types and locations of positioning equipment,
c. patient’s position and repositioning during the surgery,
d. patient’s overall skin condition preoperatively and upon discharge
from the OR, and
e photography or description of injury related to positioning.
26. Verbalizes a review of facility or health care organization policies
and procedures related to patient positioning.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 6 of 7
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Positioning, All Positions – RN
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
S/SBT/
DO/DA
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
27. Participates in assigned quaality improvement activities related to
patient positioning.

Concurrent competency verification of the following is recommended

[Additional competencies related to positioning as determined by the facility or
health care organization]



DEM/DO/DA
S/SBT/CS
RWM/P&P

=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 7 of 7