Competency Verification Tool Perioperative Services

[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

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

Petersen C, ed. Positioning injury. In: Perioperative Nursing Data Set. 3rd ed. Denver, CO: AORN, Inc; 2011:178-184.

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.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.Identifiespatientpopulationswithincreasedriskforintegumentary,respiratory,nerve,orcardiovascularcompromiserelatedtopositioningincluding
a.neonates,
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.cardiovascularcomplications(eg,increasedcardiacoutput, increased pulmonaryarterypressure,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 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,freeof 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 slidinginjuries)andperioperativepersonnel(eg,preventingbackinjuries).
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.verifyingthatallpatientjewelryand body piercing jewelry have been identified and removed or secured before positioning the patient;
c.usingsafepositioning 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;

amattressthatprovidessufficientpaddinganddoesnot “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 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.
18.Re-evaluates and collaborates with surgeon and anesthesia professional abouttheneedorpossibilitytorepositionpatientduringproceduresexceeding a designated time per facility or health care organization policy.
19.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).
20.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.
21.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.
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.placingchildreninneonatetransportvehicles 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
ephotography or description of injury related to positioning.
26.Verbalizes a review of facility or health care organization policies and procedures related to patient positioning.
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=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: ______