Competency Verification Tool Perioperative Service

[Insert Facility Name]

Competency Verification Tool—Perioperative Service

Practice: Electrosurgery – Non-RN

Name: Date:

Competency Statement: The perioperative non-RN team member has completed facility- or health care organization-required education and competency verification activities related to electrosurgery.1

Guideline for safe use of energy-generating devices.Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2016.

Outcome Statement: The patient is free from signs and symptoms of electrical injury.2

Petersen C, ed. Electrical injury. In: Perioperative Nursing Data Set. 3rd ed. Denver, CO: AORN, Inc; 2011:173-177.

Competency Statements/Performance Criteria / Verification Method
[Select applicable code from legend at bottom of page] / Not Met
(Explain why)
DEM/
DO/DA / KAT / S/SBT/
CS / V / RWM/
P&P / O
1.Explains the set-up of an electrosurgical unit (ESU) by
a.describing the difference between monopolar and bipolar electrosurgery;
b. describing foot pedal versus hand control;
c.identifying connections for active and dispersive electrodes;
d.describing correct use of reusable, dispersive electrodes; and
e.describing correct use of the disposable, dispersive electrodes.
2.Uses only facility-or health care organization-approved ESU accessories.
3.IdentifiesactionsnecessarytohelpensuresafetywhenusingtheESU by
a.verifyingthattheESUissecurely mounted to a tip-resistant surface,
b.verifying that the ESU is not used as a shelf or table,
c.verifying that liquids are not placed on the ESU,
d.covering foot pedal accessories with fluid-resistant covers when there is a potential for fluid spills on the floor,
e.verifying that safety and warning alarms are turned on to an audible level,
f.turning the ESU settings to the lowest effective power setting to achieve the desired tissue effect,
g.confirming power settings with the operating clinician before use,
h.checking the entire ESU circuit (ie, ESU, hand piece and accessories, dispersive grounding pad, foot pedal) if the operating clinician repeatedly requires higher settings,
i.handling all cords and plugs in a manner to prevent damage;
j.checking the unit and cords/plugs for fraying and damage after use;
k.placing the ESU in a manner to prevent tripping hazards from the power cord, and

enabling the cord joining the active electrode to the generator to be placed as far as possible from or at 90 degrees to other cords (eg, cardiac and neuromuscular monitoring cords light cords, second electrosurgery cords).

4.Identifies critical factors for correctly using the dispersive electrode (eg, placement over a well-perfused muscle mass, verifying uniform skin contact) by
a.choosing the proper size of dispersive return electrode for the patient (eg, does not cut the pad to fit the patient);
b.verifying that there is adequate contact between the patient and the dispersive return electrode during application of the dispersive electrode;
c.using a separate, disposable dispersive pad for each ESU when using multiple ESUs;
d.removing hair, if necessary, according to facility or health care organization policy;
e.verifying removal ofall jewelry that is in the electrosurgery current pathway; and

verifyingno metal is touching the patient (eg, metal bed components).

5.Managesthe active electrode safely by
a.connectingtheactiveelectrodetothe correctreceptacle in the ESU;
b. attaching the cord to the drapes using a non-piercing,non-conductive device;
c.placing the active electrode in the safety holster when it is not in use;
d.cleaning visible eschar off the active electrode tip away from the incision;
e.keeping the electrode cord free of kinks and coils during use; and
f.placing the protective cap on the battery-powered, hand-held electrocautery device when the device is not in use.
6.Follows fire safety precautions when using electrosurgery,including
a.monitoring that flammable prep solutions have dried completely before drapes are placed and the ESU is activated,
b.verifying that moistened sponges are used near the active electrode tip, and
c.ensuring that nonflammable materials (eg, wet towel, sterile water or saline) are available on the field to extinguish a fire should one occur.
7.Identifies considerations specific to using argon-enhanced coagulation technology.
8.Describes the precautions necessary when using electrosurgery with a patient who hasan implanted electronic device (IED) (eg, gastric or cardiac pacemaker; implantable cardioverter defibrillator; cochlear implant; deep brain, vagal nerve, sacral nerve, phrenic nerve, spinal cord, or bone stimulator).

Completes interventions recommended by the team managing the IED.

10.Verbalizes a review of facility or health care organization policies and procedures related to electrosurgery.
11.Participates in assigned quality improvement activities related to electrosurgery.
Concurrent competency verification of the following is recommended

[Additional competencies related to electrosurgery as determined by the facility or health care organization]

DEM/DO/DA=Demonstration/Direct Observation/Documentation AuditKAT=Knowledge Assessment Test

S/SBT/CS=Skills Laboratory/Scenario-based Training/Controlled SimulationV=Verbalization

RWM/P&P=Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s ______)O=Other: ______