Positioning the surgical patient requires special attention from the entire surgical team because anesthetized or sedated patients are not able to reposition themselves when needed to relieve discomfort or alert team members of the need for repositioning. Perioperative nurses must pay attention to positioning details and the possibility of injury at all times during the patient's procedure. This includes assessing the patient's circulatory, respiratory, integumentary, musculoskeletal, and neurological structures to help ensure that the patient is properly positioned and safe from injury. Working as a member of the surgical team, the perioperative RN is key to speaking up when positioning issues need to be addressed and helping to minimize the risk of injury to the patient. This "Back to Basics" article discusses positioning the patient in the prone position.

Ensuring use of best practices is crucially important in today's health care system. Nurses can identify research results that offer promising new treatment options for their patients and should have a plan for implementing research findings. The perioperative education coordinator at one facility identified the occurrence of deep vein thrombosis as a significant problem. She conducted a literature review, created an education program for nurses, and implemented an evidence-based practice change. This article describes the steps in this process. Now, patients at the facility consistently are assessed for deep vein thrombosis and receive appropriate preventive treatment.

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Background: Patients undergoing surgery in the prone position may be at risk for postoperative vision loss associated with increased intraocular pressure. The purpose of this systematic review and meta-analysis is to estimate the magnitude of the increase in intraocular pressure at specific perioperative time points in adult patients. The research question to be addressed is ''What is the magnitude of the increase in intraocular pressure at specific perioperative time points in adults undergoing surgery in the prone position?''Methods: Comprehensive search strategies were used to identify nine eligible studies (N ¼ 229). Standardized mean difference effect sizes were calculated for two intraoperative time points. Time points for meta-analysis were selected to achieve the greatest number of comparisons for analysis at each time point. Prediction intervals for each time point were also calculated to show the dispersion of true effect sizes around the mean.Results: Meta-analysis showed that intraocular pressure increased significantly between induction of anesthesia and up to 10 minutes of prone position (T1: standardized mean difference [d] ¼ 2.55; P , .001) and continued to increase significantly until the end of the prone position (T2: d ¼ 3.44; P ¼ .002).Conclusions: Intraocular pressure increases of this magnitude demonstrate the need for implementing interventions to reduce the risk for postoperative vision loss in patients undergoing surgery in the prone position.Clinical Relevance: Implementing preoperative ophthalmologic examinations for patients undergoing surgery in the prone position may help to reduce the risk for ocular injury. Intraoperative interventions that can be implemented to reduce or mitigate the increase in intraocular pressure include implementing a 5-to 10-degree reverse Trendelenburg prone position, reducing the amount of time the patient is in the prone position, considering staged procedures, monitoring intraocular pressure, providing periodic position changes or rest periods, preventing pressure on the eye, and administering specific medications or anesthetics. ComplicationsKeywords: intraocular pressure, prone position, ischemic optic neuropathy, central retinal artery occlusion Pathogenesis of Postoperative Vision LossPostoperative vision loss in patients undergoing surgery in the prone position is generally related to 1 PurposeAlthough some researchers have studied the quantitative increase of IOP in surgical patients in the prone position, 1,2,14,16,17,34,50 there is a need for systematic review and meta-analyses of these studies to demonstrate the overall effect size and provide high-quality evidence supporting, or negating, the

The purpose of this Evidence Review column is to provide information about current literature of relevance to plastic and aesthetic nurses.

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AORN perioperative practice specialists responsible for authoring the Guidelines for Perioperative Practice have spent several years using evidence-based practice tools adapted from other organizations. AORN now has its own evidence appraisal tools and model for evidence-based practice that can be used by nurses and students to appraise research and nonresearch articles and assign an evidence rating to help inform perioperative practice decisions. The new and revised tools include a new evidence rating model, hierarchy of evidence, and expanded appraisal tools.

Specific actions for handling various types of specimens may differ; however, the management process is essentially the same. Accurate specimen management requires effective multidisciplinary communication, minimal distractions, and awareness of the opportunities for error. When advocating for patients and working with members of the health care team to provide a safe perioperative environment, perioperative nurses should adhere to best practices for specimen management and strive to prevent specimen-related errors that may lead to inaccurate or incomplete diagnoses, the need for additional procedures, and perhaps most importantly, physical and psychological injury to patients.