ACORN Standards evidence summaries

Evidence summaries informing the 16th edition of the ACORN Standards 

In mid 2019 ACORN commissioned the JBI to develop an evidence summary of the best available evidence related to perioperative nursing for:

  • Antimicrobial stewardship (new release in 2020)
  • Budget preparation and monitoring (major revision in 2020)
  • Chlorhexidine (CHG) sensitivity (new release in 2020)
  • Latex sensitivity (major revision in 2020)
  • Multiple-resistant organisms (new release in 2020)
  • Staffing requirements (major revision in 2020)
  • Wellbeing (new release in 2020).

During the commission, JBI worked with the author of each standard and ACORN's Standards Manager to develop an individual standard PICO (Patient/population, Intervention, Comparison and Outcome) question that JBI could apply to their rapid searches for the best available evidence. In targeting the best available evidence JBI focused on systematic reviews, evidence-based guidelines and then primary research that measured the effects or effectiveness of health care policy and practice. JBI searched the following bibliographic citation databases to locate relevant studies.

  • MEDLINE via Pubmed;
  • JBI Database of Systematic Reviews and Implementations Reports
  • JBI EBP Databse via OVID
  • Cochrane Library
  • Guidelines International Network Library.

Each search was limited to the last five years for contemporary literature and limited to English language papers only. The reference lists of included studies were reviewed to identify additional studies of relevance.

Following the search, JBI critically appraised data from identified reviews, studies, guidelines and other forms of evidence using the appropriate JBI critical appraisal tools. (JBI critical appraisal tools are available from The quality of the evidence was evaluated and key characteristics extracted to inform the evidence summary underpinning each standard.

Following critical appraisal relevant studies were extracted against the template for data extraction to identify key outcome data. In the absence of research, evidence, text and opinion was extracted to ensure answers to each topic were based on publicly accessible and vetted knowledge.

Additional evidence was identified based on each standard's specialised team's content expertise and review of the reference lists of the primary citations. The specialised team included an author and several co-authors. The author allocated individual articles to two co-authors for review and critical appraisal using the appropriate AORN research or non-research evidence appraisal forms. An appraisal score was determined by each appraiser. Concordant appraisal scores were accepted as the consensus score. Where appraisers’ scores differed a third team member independently appraised and reviewed the article and a consensus score was determined. Consensus scores were assigned to each article based on the strength and quality of evidence.

ACORN's Standards Manager mapped the original JBI levels of evidence against the Association of periOperative Registered Nurses (AORN) levels of evidence7, 8 and associated implementation imperative ratings. Practices supported by evidence graded as Grade A by JBI were designated as implementation imperative rating 2: ‘Recommendation’ according to AORN ratings; practices supported by evidence graded as Grade B by JBI were designated as implementation imperative rating 3 'Conditional recommendation' according to AORN levels of evidence7, 8 and ratings. Regulatory requirements were graded as 1: ‘Regulatory requirement’ and where the evidence was poor quality or questionable an AORN rating of 4: ‘No recommendation’ was applied. Recommendations for practice, as per the statements in each standard, guideline or position statement, were informed by the evidence and, based on AORN levels of evidence7, 8, are listed after each statement as an implementation imperative rating of either ‘Regulatory requirement’, ‘Recommendation’, ‘Conditional recommendation’ and ‘No recommendation.

Factors considered by each specialised team and the Standards Manager in the review of the collective evidence were the quality of the evidence, the quantity of similar evidence on a given topic and the consistency of evidence supporting a recommendation. Each team is of the view that the assigned implementation imperative ratings are appropriate for evidence-based Australian perioperative nursing care at the time of writing.

ACORN's long-term goal is to ensure its recommendations are based on current, high-quality evidence. However, the resources and time required to achieve and sustain that goal are currently beyond ACORN's reach. The ACORN Roadmap Project is currently reviewing the evidence base for ACORN Standards.

JBI Evidence summaries prepared from 2011 - 2019 are available for downloading below. They are categorized according to the standard they informed. Please note that minor reviews of individual standards have been undertaken in editions published since the original evidence summary.

  1. Jordan Z, Lockwood C, Aromataris E and Munn Z. The updated JBI model for evidence-based healthcare. Adelaide, South Australia: The Joanna Briggs Institute 2016;
  2. Pearson A, Jordan Z and Munn Z. Translational science and evidence-based healthcare: A clarification and reconceptualization of how knowledge is generated and used in healthcare. Nursing research and practice 2012;2012(
  3. Pearson A, Wiechula R, Court A and Lockwood C. The JBI model of evidence-based healthcare. International Journal of Evidence-Based Healthcare 2005;3(8):207-215.
  4. Jordan Z, Lockwood C, Munn Z and Aromataris E. Redeveloping the JBI model of evidence based healthcare. International journal of evidence-based healthcare 2018;16(4):227-241.
  5. Spruce L, Van Wicklin SA, Hicks RW, Conner R and Dunn D. Introducing AORN's new model for evidence rating. AORN J 2014;99(2):243-255.
  6. Spruce L, Van Wicklin SA and Wood A. AORN's revised model for evidence appraisal and rating. AORN J 2016;103(1):60-72.
  7. Wood A. Updates to the AORN evidence rating model. AORN J 2019;110(1):5-8.
  8.  Association of periOperative Registered Nurses (AORN). AORN guidelines for perioperative practice 2019. Denver, CO: AORN Inc; 2019.