SECT2.05 - Recommended Practices for Electrosurgery - Medline

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RP: ElectrosurgeryXI.b.1.Incorrect use can result in serious injuryto patients and personnel.If multiple types of electrosurgicalequipment are used within the facility,training should be provided on all ofthe equipment. 18XI.c. Personnel should be instructed in the risksof electrosurgery during minimally invasivesurgical procedures.Direct coupling is the result of touchingthe laparoscopic active electrode to anotheranatomic structure. This can cause necrosisof underlying tissue. Insulation failure of thelaparoscopic electrode can be caused bytrauma during use or reprocessing. Currentleaves the electrode through this alternatepathway. This can cause serious patientinjury, particularly when the injury is internal.Capacitive-coupled RF currents cancause undetected burns to nearby tissue andorgans outside the endoscope’s viewingfield. Severe patient injuries have resulted. 8XI.d. Perioperative registered nurses should beknowledgeable about the types of IEDs thatmay be encountered in the practice setting,and the precautions that must be takenwhen caring for patients with these devices. 25Electronic devices implanted in a patientmay be affected by other IEDs or medicalequipment with which a patient may comeinto contact in a health care facility.XI.e. Administrative personnel should assess anddocument annual competency of personnelin the safe use of the ESU and accessories.A competency assessment provides arecord that personnel have basic understandingof electrosurgery, its risks, andappropriate corrective actions to take in theevent of a fire or injury. This knowledge isessential to minimize the risks of misuse ofthe equipment and to provide a safe environmentof care.Recommendation XIIDocumentation should be completed to enablethe identification of trends and demonstrate compliancewith regulatory and accrediting agencyrequirements.Documentation of all nursing activities performedis legally and professionally important forclear communication and collaboration betweenhealth care team members and for continuity ofpatient care.XII.a. Documentation using the PNDS shouldinclude a patient assessment, a plan of care,nursing diagnoses, identification of desiredoutcomes, interventions, and an evaluationof the patient’s response to the care provided.Documentation provides communicationamong all care providers involved in planningand implementing patient care.XII.b. Documentation should be recorded in amanner consistent with health care organizationpolicies and procedures and shouldinclude, but is not limited to– electrosurgical system identificationserial number; 102– range of settings used;– dispersive electrode placement;– patient’s skin condition before dispersiveelectrode placement;– patient’s skin condition after removal ofdispersive electrode; 102– adjunct electrosurgical devices used (eg,ultrasonic scalpel, bipolar forceps); and– safety holster use. 18Recommendation XIIIPolicies and procedures for electrosurgery shouldbe developed, reviewed periodically, revised as necessary,and readily available in the practice setting.Policies and procedures assist in the developmentof patient safety, quality assessment, andimprovement activities. Policies and proceduresestablish authority, responsibility, and accountabilitywithin the facility. They also serve as operationalguidelines that are used to minimize patientrisk factors, standardize practice, direct staff members,and establish guidelines for continuous performanceimprovement activities.XIII.a. The health care organization’s policies andprocedures for electrosurgery must be incompliance with the Safe Medical DevicesAct of 1990, amended in March 2000. 26XIII.a.1. When patient or personnel injuries orequipment failures occur, the ESU112Equipment and Product Safety2012 Perioperative Standards and Recommended Practices
RP: Electrosurgeryshould be removed from service andthe active and dispersive electrodesretained if possible. 102Retaining the ESU, the active and dispersiveelectrodes, and packaging allowsfor a complete systems check to determineelectrosurgical system integrity. 102XIII.a.2. Incidents of patient or personnel electricalinjury or equipment failureshould be reported as required by regulationto federal, state, and localauthorities and to the equipment manufacturer.102 Device identification, maintenanceand service information, aswell as adverse event informationshould be included in the report fromthe practice setting.Documentation of details of the electrosurgicalequipment and suppliesallows for retrievable information forinvestigation into an adverse event. 102XIII.b. Policies and procedures for electrosurgeryshould include, but are not limited to thefollowing:– safety features required on ESUs;– equipment maintenance programs;– required supplemental safety monitors;– equipment checks before initial use;– reporting and impounding malfunctioningequipment;– reporting of injuries;– preoperative, intraoperative, and postoperativepatient assessments;– precautions during use;– ESU sanitation; and– documentation.XIII.c. An introduction and review of policies andprocedures for electrosurgery should beincluded in orientation and ongoing educationof personnel to assist in the developmentof knowledge, skills, and attitudes thataffect surgical patient outcomes.Review of policies and procedures assistshealth care professionals in the developmentof knowledge, skills, and attitudes thataffect patient outcomes.XIII.d. A written fire prevention and managementpolicy and procedure should be developedby a multidisciplinary group that includesall categories of perioperative personnel. 18,36Fire is a risk to both patients and healthcare workers in the perioperative setting.XIII.d.1. The policy and procedure shouldde scribe processes to be implementedto safely manage different fire scenarios.Recommendation XIVA quality assurance/performance improvement processshould be in place that measures patient, process,and structural (eg, system) outcome indicators.A fundamental precept of AORN is that it is theresponsibility of professional perioperative registerednurses to ensure safe, high-quality nursingcare to patients undergoing surgical and invasiveprocedures. 103XIV.a. Structure, process, and clinical outcomesperformance measures should be identifiedthat can be used to improve patient careand that also monitor compliance withfacility policy and procedure, national standards,and regulatory requirements. 104XIV.a.1. Process indicators may include, but arenot limited to information about adversepatient outcomes and near misses associatedwith electrosurgery, which shouldbe collected, analyzed, and used forperformance improvement. 103XIV.b. Electrosurgical devices should be testedbefore initial use, inspected periodically,and receive preventive maintenance by adesignated individual responsible for equipmentmaintenance (eg, biomedical engineeringservices personnel). 19Periodic preventative maintenanceensures continued safe operation of electrosurgicaldevices. 19XIV.c. Each ESU should be assigned an identificationor serial number.This number allows designated personnelto track function problems and documentmaintenance performed on individual ESUs.XIV.d. Each health care organization should beresponsible for staying abreast of evolvingtechnology that may impact patient careand safety.Electrosurgical technology continues toevolve, changing the way in which surgicalhemostasis is achieved.2012 Perioperative Standards and Recommended Practices Equipment and Product Safety 113
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SECT2.05 - Recommended Practices for Electrosurgery - Medline

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