Roadmap Project Updates

As the RMP continues to progress ACORN will use this page to publish updates and early-release information related the RMP and the ACORN Standards.

Over the past few weeks ACORN has received several queries from perioperative nurses that relate to issues beyond the scope of the ACORN Standards. These questions have prompted ACORN to again try to clarify the role of the ACORN Standards and how they can best serve Australia's perioperative nurses. ACORN also considers it time to reiterate the authority of not only the ACORN Standards but also other documents that guide perioperative practice. 

In the 16th edition, published in May 2020, eagle-eyed readers may have noticed the inclusion in every standard of the following words: ‘National and jurisdictional statutory requirements must be followed and take precedence over all recommendations contained within this standard. This standard should be used in conjunction with other current, relevant ACORN standards, and national and jurisdictional statutory requirements, standards and guidelines’.

The words above signify ACORN's deliberate action to position the ACORN Standards as being an adjunct to, not an alternative for, higher order directives including any relevant legislative instruments, national mandates and state or territory guidelines and policy. Each of those alternative directives take priority over the ACORN Standards in terms of the perioperative nurse's rights, obligations and responsibilities. Critical examples include the relevant Nursing and Midwifery Board of Australia (NMBA) professional standards and the mandatory Australian Commission on Safety and Quality in Health Care (ACSQHC) National Safety and Quality Health Service Standards (NSQHS Standards) that enshrine certain Standards Australia standards. There are other examples including various laws governing medications, medical devices and clinical practice. The list is exhaustive and beyond the scope of this brief discussion.

In view of the above hierarchy a perioperative nurse could reasonably ask what, then, is the role of the ACORN standards? Do they cover every aspect of perioperative nursing and do they have any authority? The role of the ACORN Standards is an important one and is described well in the final statement on the Acknowledgment page of the 16th edition of the ACORN Standards, as reproduced below.

No government or other agency requires compliance with the ACORN Standards; however, compliance is the key to organisations and individuals ensuring perioperative care is consistently safe and of high quality. As such, it is ACORN’s goal that ACORN standards for practice are accessed, interrogated and applied in every Australian health service organisation that performs surgical procedures. Perioperative staff should use the ACORN Standards in conjunction with other national and jurisdictional legislation, guidelines and requirements including, specifically, the National Safety and Quality Health Service Standards (NSQHS Standards). It is hoped that the ACORN Standards continues to represent the minimum expected, by the profession and its stakeholders, of all perioperative staff.

Frequent users of the ACORN Standards will note ACORN's silence on some specific aspects of perioperative nursing practice and perhaps wonder why that is the case. The primary reason ACORN remains silent on specific issues is that their resolution is dependent on a higher order directive, as detailed above. In those cases, there is no need for ACORN to offer a view as the necessary advice and instruction is already available. In fact, it could be confusing for perioperative nurses and has the potential to fuel local debate and disagreement if ACORN were to suggest an alternative view or unnecessary direction. For some matters there may be a specific national, state or organisational obligation or directive and that is what must be followed. Two examples of such matters that ACORN has recently dealt with are staffing and scope of practice for enrolled nurses. 

Other examples where the ACORN Standards are silent include where set-up should take place, whether or not multiple patients' notes should be in one operating room and how blood loss should be recorded. With no higher order directives nationally and within most jurisdictions, why are these issues not addressed? These issues are important but, alone, none are of such importance that they require a specific, individual standard. Rather, each is more likely to fall under the scope of higher order directives such as the NSQHS Clinical governance standard, Preventing and controlling healthcare-associated infection standard and Blood management standard.

As members are aware, ACORN's Roadmap Project (RMP) is currently considering the future direction and content of the ACORN Standards. Future ACORN practice standards will be brief, succinct and clear. Their structure will be as described in the November RMP update (see below). 

On the 30th September 2020 the National Leadership Group (NLG) agreed on the new definition of an ACORN standard and its structure. This is a seminal moment in the project as the new definition and structure will inform the content and format of the next edition of the ACORN Standards. It is likely but not definite that, as in the current edition, the next edition will have two sets of standards:

  1. safety and quality standards (Standards for Safe and Quality Care in the Perioperative Environment or SSQCPE)
  2. practice standards (Professional Practice Standards for Perioperative Nurses).

Collectively, these two sets of standards will be known as the ACORN Standards.

Structure and definition of an ACORN standard

Standards provide a benchmark against which performance can be measured. 

ACORN’s safety and quality standards identify benchmarks to support safe, consistent and reliable care to patients. The ACORN practice standards for perioperative nurses outline the level of performance expected from nurses within the perioperative environment to support the provision of high-quality nursing care.

The ACORN Standards are under constant review and consideration. Changes in the environment trigger evaluation of existing standards and where needed the development of new standards. 

The ACORN Standards, where appropriate, link to those set by Standards Australia (SA), the National Safety and Quality Health Service Standards (NSQHS Standards)1 set by the Australian Commission on Safety and Quality in Health Care, and the Registered nurse standards for practice2 and Enrolled nurse standards for practice3 set by the Nursing and Midwifery Board of Australia (NMBA). 

The two sets of ACORN standards aim to protect patients and staff from harm and to maximise the quality of perioperative care and conditions. 

Adoption of the ACORN standards enables organisations and individuals to demonstrate that they are meeting minimum requirements and providing safe, quality perioperative nursing care.

ACORN standards for safe and quality perioperative care are structured as follows.

  1. Standard: this describes the high-level outcome for the standard.
  2. Criterion: outlines the elements of the standard against which measurement can be made, e.g. actions, processes or procedures.
  3. Guidance: explains and expands the concepts and elements in the criterion. It contains references to the research/scientific evidence underpinning the standard. 
  4. Evidence demonstrating how the standard is met: illustrative examples of the type of evidence which organisations can provide in order to demonstrate achievement of the standard.
  5. Links to NSQHS, SA and NMBA will be indicated, as relevant.

ACORN will make available links to and information on resources and tools to support implementation and achievement of the standards.

References

1.         Australian Commission on Safety and Quality in Health Care (ACSQHC). National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2017 [cited 2020 July 28]. Available from: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/national-safety-and-quality-health-service-standards-second-edition.

2.         Nursing and Midwifery Board of Australia (NMB). Registered nurse standards for practice. Sydney: NMBA;2016 [cited 2020 July 28]. Available from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx.

3.         Nursing and Midwifery Board of Australia (NMB). Enrolled nurse standards for practice. Sydney: NMBA;2016 [cited 2020 July 28]. Available from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/enrolled-nurse-standards-for-practice.aspx.