NOVEMBER 1998, VOL 68, NO 5 C O M M I T T E E R E P O R T

Data elements are the key to defining perioperative activities

ur description of perioperative practice is reflected in the language that we use to communicate with others. Clearly, lan-

guage and terminology help portray this description for all to understand. Communicating and describ- ing perioperative practice is the primary goal of the Data Elements Coordinating Committee (DECC). An expansive amount of work has been completed since the inception of DECC in 1993. This report will provide an update on the progress of the five major areas that have evolved since the committee was formed as they relate to perioperative practi- tioners. These areas include

identification of perioperative nursing diagnoses relevant to surgical patients, perioperative nurses’ description of nursing interventions to meet those needs, expansion of outcomes to reflect current practice patterns, recognition of the perioperative nursing manage- ment components of the practice, and development of a systematic method for devel- oping specific practice initiatives.

PERIOPERATIVE NURSING DIAGNOSES

he committee members reviewed the literature T to identify the most commonly used nursing diagnoses in perioperative practice. The review included the AORN Journal, perioperative text- books, and a variety of other resources. A survey of AORN members then was conducted involving 60 of the most commonly identified nursing diagnoses. Participants were asked to rank the diagnoses with weighted means. This information provided three ranked categories of nursing diagnoses:

nursing diagnoses that nurses perceived as being most critical to patient outcomes, primary perioperative nursing diagnoses, and secondary perioperative nursing diagnoses.

This process demonstrates that perioperative nurses use language that reflects clinical decision making in practice.’

PERIOPERATIVE NURSING INTERVENTIONS

I perioperative nurses complete in providing patient care (eg, verifying allergies, confirming identity before surgical or invasive procedures, per- forming required counts, implementing aseptic technique). One researcher shared the original work that linked nursing actions to our accepted “Patient Outcomes: Standards of Perioperative Care,” found. in the AORN Standards, Recommended Practices, and Guidelines.2 This original work was the basis of the committee’s Perioperative Nursing Data Ele- ments: intervention^.^ The intervention elements have been identified, refined, and expanded by committee members.

The committee then reviewed perioperative nurs- ing literature and identified operational definitions for aII cognitive and psychomotor activities. Recognized data from previous works were reviewed and includ- ed the emerging frameworks from the

ntervention data elements are the actions that

American Nurses Association, American Nurses Publishing, Home Health Care Classification, Omaha System, North American Nursing Diagnosis Association (NANDA), Nursing Diagnosis Interventions and Client Out- comes, Nursing Intervention Classification (NIC), and Nursing Sensitive Outcomes Classification (NOC). These data sets were reviewed and compared to

the committee’s work. The Nursing Practices Com- mittee now is working with DECC to continue to realign the interventions with new outcomes and will proceed to define and refine intervention data elements as they relate to anticipated outcomes.

PERIOPERATIVE OUTCOMES

0 current practice. For example, an outcome statement indicating that a patient is free from signs

utcome statements were expanded to reflect

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and symptoms of injury has been expanded to eight new outcome statements that explicitly identify the potential type of injury. These outcome statements include that the patient is free from signs of physi- cal injury, injury due to extraneous objects, chemi- cal injury, electrical injury, positioning injury, laser injury, radiation injury, and transfer/transport injury. A survey of AORN members revealed respondents strongly agree that these expanded out- comes statements are significant to current periop- erative practice.

PERIOPERATIVE NURSING MANAGEMENT ELEMENTS

N environment in which the practice is complet- ed. These elements vary from definitions of times for procedures to ranges of norms for resource requirements to delivery the services. They are use- ful for identifying consistency in practice, bench- marking, and applying research in clinical settings.

The Association of Anesthesia Clinical Direc- tors offers a “Glossary of times used for scheduling and monitoring of diagnostic and therapeutic proce- dure~.’’~ Members of DECC acquired approval to use the glossary and added other measures to reflect staffing requirements, utilization reviews, financial aspects, and environments. For example, utilization review includes a variety of times, such as room use with turnover time, room use without turnover time, and hours of use per surgical special- ty. AORN collaborated with Education Design, Inc, to develop a tool to reflect these activities as poten- tial benchmark indicators. Respondents of a 1998 survey of AORN members agree that these items are important.

ursing structure data elements identify the

NOTES 1. A R Killen et al, “The preva-

lence of perioperative nurse clinical judgments,” AORN Journal 65 (Jan- uary 1997) 101-108.

2. S V Kleinbeck, “In search of perioperative nursing data ele- ments,” AORN Journal 63 (May

GUIDELINES

astly, DECC members identified a systematic L method for developing practice initiatives that can function as a template for guideline standardiza- tion. This method differs from the AORN Standards, Recommended Practices, and Guidelines because it is based on expert opinion and available science, includ- ing reliability, reproducibility, and scientific validity.

THE VALUE OF DECC

ow does the work of DECC relate to our clin- H ical practice? Thanks to DECC, we now have substantiating evidence for each major category of perioperative practice. This provides documenta- tion of empirically based outcomes, interventions, and diagnoses. There is consistent language for each care component and data for measurement of care and outcomes. The language is clearly stan- dardized and consistent with other data sets such as NIC, NOC, and NANDA nursing diagnoses. We can recognize common components and begin to measure and link patient care with expected out- comes. We can continue to delineate the links from each of the data sets. These component parts pro- vide the building blocks of our language.

The work of DECC has provided the logic to fit the pieces of perioperative practice and patient care together. AORN can use this information to com- municate, describe, and demonstrate clinical deci- sion making of the professional practitioner. It is exciting to recognize that we are able to clearly substantiate our professional practice.

PAUU MORTON RN, MS

DATA ELEMENTS COORDINATINQ COMMITTEE MEM~ER

1996) 926-93 1; “Patient outcomes: Standards of perioperative care,” in AORN Standards, Recommended Practices, and Guidelines (Denver: Association of Operating Room Nurses, Inc, 1998) 141-149.

3. Kleinbeck, “In search of perioperative nursing data ele-

ments,” 926-93 1. 4. R T Donham; W J Mazzei; R

L Jones, “Glossary of times used for scheduling and monitoring of diag- nostic and therapeutic procedures,” The American Journal of Anesthesi- ology 23 (September/October 1996) 3-12.

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