AORN Journal CE Articles

This April issue includes a CE article on the pathophysiology of twin-to-twin transfusion syndrome and preoperative and intraoperative patient care requirements for patients undergoing laparoscopic-assisted fetoscopic placental laser photocoagulation procedures, and a CE article on enhancing perioperative hand-over communication. The Clinical Issues column explores scrubbed team members leaving the OR while x-rays are taken, cleaning radiation protection garments and devices, implementing radiation precautions for pregnant health care workers, protecting patients from radiation exposure, and wearing x-ray aprons that fit correctly.

1. Perioperative Care of Patients Diagnosed With Twin-to-Twin Transfusion Syndrome Undergoing Laparoscopic-Assisted Fetoscopic Placental Laser Photocoagulation

Twin-to-twin transfusion syndrome (TTTS) is a condition that results in unbalanced blood flow between two fetuses. Depending on the severity of TTTS, laser ablation of placental anastomoses may be the most effective treatment. The preferred treatment method requires percutaneous entry to the uterus; however, some patient circumstances require a laparoscopic-assisted procedure. Perioperative nurses should have knowledge of the pathophysiology of TTTS, including its natural progression. They also should understand preoperative and intraoperative patient care requirements to provide safe and effective care for patients undergoing laparoscopic-assisted fetoscopic placental laser photocoagulation procedures.

2. Safety First: Using the Performance Improvement Process to Enhance Perioperative Hand-Over Communication

According to The Joint Commission, a handoff (or hand over) is the “transfer and acceptance of patient care responsibility achieved through effective communication.” However, there is a risk for miscommunication and patient harm with each hand over. Because some perioperative hand overs are inevitable (eg, transfer of care from the preoperative area to the OR, RN circulator breaks), perioperative leaders should facilitate safe patient hand overs and implement effective communication strategies. Developing a standardized hand-over tool and workflow that includes use of a mnemonic device can help prevent communication errors that may result in adverse events.

Clinical Issues—April 2021

• Scrubbed team members leaving the OR while x-rays are taken
• Cleaning radiation protection garments and devices
• Implementing radiation precautions for pregnant health care workers
• Protecting patients from radiation exposure
• Wearing x-ray aprons that fit correctly