AORN Guideline for Specimen Management - PowerPoint Presentation

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AORN Guideline for Specimen Management - PPT Presentation

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AORN Guideline for Specimen Management

Slide2

BSN and MSN: Middle Tennessee State University Membership: Phi Kappa Phi, Sigma Theta Tau Honor SocietyCertification:CNOR CRNFA (RN first assistant)CPSN (plastic and reconstructive surgical nursing) PLNC (legal nurse consultant)Recipient: AORN Outstanding Achievement in the Application of Perioperative Clinical Research Award, 2005.

Developed and originally presented bySharon A. Van Wicklin, MSN, RN, CNOR, CRNFA(E), CPSN-R, PLNCSenior Perioperative Practice Specialist, AORN

These

slides were

taken from the webinar

Recommended Practices for Specimen Management,

presented

August 20, 2014.

To listen to the webinar, visit https://www.aorn.org/Events/Webinars/Previously_Recorded_Webinars.aspx. These slides are made available for educational use. Slides may be personalized for your facility and presentation. HOWEVER, THE VIEWS EXPRESSED IN THESE SLIDES ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS

AND SHOULD NOT BE ATTRIBUTED

AORN.

Slide3

Describe the specimen management processExplain best practices for handling surgical specimensIdentify alternatives to formalin for specimen preservationDiscuss recommendations for specimen disposition

Objectives

Slide4

The AORN guideline depicts the actions and role of the perioperative RN as the manager ofthe patient’s care The specimen management process is the same for all types of specimens

Specimen Management

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Needs assessmentSite identificationCollection and handlingTransferContainmentIdentification and labelingPreservationTransportDispositionDocumentation

Specimen Management

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The guideline provides guidance for management of surgical specimens in the perioperative practice setting, includingBreast cancer specimensAmputated digits and limbs Forensic specimensRadioactive specimensExplanted medical devicesExplanted orthopedic hardware

Specimen Management

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The guideline does not cover:Surgical techniques for resection of specimensClinical laboratory specimensRefer to 42 CFR 493, Laboratory Requirements

Specimen Management

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Requires:Multidisciplinary communicationMinimized distractionsAwareness of opportunities for error. Errors can lead toinaccurate or incomplete diagnosesthe need for additional proceduresphysical and psychological injury

Specimen Management

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Most errors are caused bySlips (unintended actions)Lapses (omissions of intended actions)Errors are a result of automatic actions, which makes them difficult to preventRedundancy has the potential to reduce errors

Specimen Management

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Recommendations

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Early assessmentShould begin when the need for obtaining a specimen is identifiedAssess cultural preferences Preoperative briefing

Recommendation I

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Confirm the specimen siteDisplay photographs that help to identify the location of dermatologic lesions to be removed and reduce the risk of wrong site surgery

Recommendation II

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Collection and handlingBreast cancer specimensAmputated digits and limbsForensic specimensRadioactive specimensExplanted medical devicesExplanted orthopedic hardware

Recommendation III

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Breast cancer specimensDocument Time of excisionTime of fixationTime from excision to fixation should be less than one hour

Recommendation III

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As the specimen is excised, reduction and elimination of blood flow results in progressive hypoxia, ischemia, and tissue degradationNucleic acid and protein changes occur that can negatively affect accuracy of the histological examination and biomolecular evaluation of the sample

Recommendation III

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Nucleic acid and protein changes cease when the fixation process beginsIndividualized chemotherapeutic agents used to treat breast cancer are derived from molecular and genetic signatures found in the sample

Recommendation III

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Amputated digits and limbs CoolHandle gentlyWrap in moist spongesPlace in a plastic bag, then in another plastic bag or chest filled with ice

Recommendation III

Slide18

Forensic evidenceEstablish the chain of custodyDocument informational evidencepatient statements, bodily marks, blood stains, unusual odorsTake photographs Label each piece of evidencePlace evidence in a sealed evidence bag or envelope

Recommendation III

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Radioactive specimens Use standard precautionsPolicies and procedures shouldbe developed by a multidisciplinary teamalign with local, state, and federal regulations define when personal shielding and exposure monitoring is required

Recommendation III

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Explanted medical devicesCollect and handle according to the health care organization’s policies and proceduresmanufacturers’ instructionslocal, state, and federal regulations

Recommendation III

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Explanted medical devices that are subject to medical device tracking regulation must be reported to the manufacturerSerious injury related to an implanted medical device must be reported to the device manufacturerDeaths related to an implanted medical device must be reported to both the manufacturer and the US Food and Drug Administration

Recommendation III

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Explanted orthopedic hardwareFollow the health care organization’s policiesVerify that the explanted hardware has not been recalled by the manufacturerDocument return of the explanted hardware

Recommendation III

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Explanted orthopedic hardwareMay be excluded from submission to the pathologist for examination, provided there is an alternative policy in place for documentation of surgical removal

Recommendation III

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Questions and Answers

Slide25

Transfer of specimen from the sterile fieldUse standard precautions and sterile techniqueMaintain cellular structureKeep the specimen moistDon’t place on dry surfacesTransfer as soon as possibleVerify identity of the specimenUse a “write down, read back” technique

Recommendation IV

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Specimen containmentUse leak-proof containersContainers should be large enough tofully contain the specimenallow the preservative to contact all surfaces

Recommendation V

Slide27

Identification and labelingConfirm Patient identification using two unique identifiersIdentification of the specimen with the surgeon using a “write down, read back” techniqueVerify specimen identification and labeling during debriefing

Recommendation VI

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Debriefing verification should includeVisual confirmation that the specimen is in the containerVerification thatpatient information on the label and requisition is correct the number and types of specimens are correctthe specimen has been correctly fixedConfirmation of other pertinent information

Recommendation VI

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Discard or remove unused labels from the procedure room at the end of procedure.Affix identification labels to the container not the lid.Label specimen containers to communicate chemical preservative and biohazard information.

Recommendation VI

Slide30

Locations where formalin is dispensedPosted signs warning of formaldehyde useEyewash stations available in the immediate areaVentilation requirements

Recommendation VII

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Eyewash stationsTravel time no greater than 10 secondsUnobstructed access on same level with no doorsStore formalin outside of the procedure room

Recommendation VII

Slide32

The volume of formalin used to fix specimens is not agreed uponVaries between 2:1 and 20:1Volume ratio should be determined by the pathologist

Recommendation VII

Slide33

FormalinMost widely used chemical for tissue fixationToxic and potential carcinogenMay not provide the most effective preservation of genetic and biomolecular signatures

Recommendation VII

Slide34

Alternatives to formalinUnder-vacuum sealingHoney-based fixativesAlcohol-based fixativesEthanolFormalin substitutes

Recommendation VII

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Transportation of specimensMust be stored in a manner that maintains integrity of the specimenMust be labeled to communicate chemical and biohazard informationMust be transported in a manner that protects personal health information

Recommendation VIII

Slide36

Policies and procedures for disposition of specimens shouldstate that a pathologist will perform an examination of the specimen when requested by the physician or licensed independent practitioner or when the pathologist determines a pathology examination is indicated

Recommendation IX

Slide37

address the diagnostic needs of medical personnel, including the potential for discovery of significant findings in specimens that are typically exempted from pathology examination, and address the potential for medicolegal implicationsinclude an alternative procedure for documenting the removal and disposition of any specimens or devices not submitted to the pathologist for examination

Recommendation IX

Slide38

Recommendation X

Nursing activities related to specimen management should be documented in a manner consistent with facility or health care organization policies and procedures and regulatory and accrediting agency requirements.

Slide39

Questions and Answers

Slide40

Specimen Management

Slide41

Specimen Management

Slide42

Specimen Management: Answers

There is an unlabeled specimen in the container on the shelf (VI)

Slide43

Specimen Management: Answers

There is an unlabeled specimen in the container on the shelf (VI)The specimen container is leaking (V.b.)

Slide44

Specimen Management: Answers

There is an unlabeled specimen in the container on the shelf (VI)The specimen container is leaking (V.b.)The breast biopsy specimen is drying on an absorbent towel (III.a.2.)

Slide45

Specimen Management: Answers

There is an unlabeled specimen in the container on the shelf (VI)The specimen container is leaking (V.b.)The breast biopsy specimen is drying on an absorbent towel (III.a.2.)The breast biopsy specimen has not been fixed within one hour (III.a.1.)

Slide46

Specimen Management: Answers

Slide47

Guideline for specimen management. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

References

Slides 11, 13, 17, 20, 23, 30, 36, 37, 38, 39, 57, 58, 59, 66: Office.com Clip Art Royalty-free photos and illustrations

Slide48

Questions and Answers