Roadmap Project updates

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

On 15 September 2021, the Roadmap Projects’ National Leadership Group (NLG) met for the last time. That final meeting provided an opportunity for each NLG member, the NLG Chair, Deb Thoms, and ACORN CEO, Rebecca East, to reflect upon the incredible journey of the ACORN Roadmap Project.

The eight members of the NLG have met ten times throughout the project. They have responded to hundreds of emails and reviewed more than one hundred drafts of the new Professional Practice Standards for Perioperative Nurses (PPSPNs). They have also read, interrogated and discussed multiple reports and recommendations from the respective Roadmap Project workstream teams. The NLG members undertook these activities in a volunteer capacity, often starting very early and working late, in addition to demanding full-time work and family commitments. They also withstood the impact of COVID-19 on this critical project, in particular, the uncertainty the pandemic brought. The members of the NLG provided ACORN with a range of perspectives we would have otherwise missed – members who were not from the immediate perioperative environment ensured objectivity in the NLG's decisions; conversely, the views and insights from the perioperative nurse members ensured that ACORN's members were very rightly well represented.

The NLG's primary outputs are a series of PPSPNs that are not only founded in relevant public policy and evidence but that also reflect nurses' unique roles and positions in the contemporary Australian perioperative setting. The NLG has also developed and approved an operating protocol for the prioritisation, development, review, amendment, approval and release of future ACORN standards.

At the end of the 15 September meeting, the NLG's chapter in ACORN's rich history closed. The story continues, however. ACORN looks forward to soon sharing with all of its members further specifics on the planned 2022 release of the new ACORN Professional Practice Standards for Perioperative Nurses (PPSPNs) and the new ACORN Standards for Safe and Quality Care in the Perioperative Environment (SSQCPE). Like the NLG, ACORN profoundly understands and respects that these are not ACORN's standards; they are, in fact, your standards and always should be.

At its most recent meeting, the National Leadership Group (NLG) of the Roadmap Project (RMP) agreed that, for the first time, the ACORN standards will be published in two separate publications. So, in May 2022, we look forward to members' responses to the first edition of the Professional Practice Standards for Perioperative Nurses (PPSPN) and, similarly, the first edition of the Standards for Safe and Quality Care in the Perioperative Environment (SSQCPE). Together, they will be the New ACORN Standards collection.

The NLG's decision to separate the professional standards from the safety and quality standards was deliberate and strategic. The NLG firmly believes that this will improve the usability of the PPSPNS and the SSQCPEs for members and subscribers. The NLG also respects the rich history of ACORN’s practice standards, published since 1977, and emphatically instructed ACORN to retain the overarching title of ‘ACORN Standards’. The choice to include ‘New’ in the title of the collection symbolises an important and progressive milestone in the life of the ACORN Standards – the point where ACORN’s members formally differentiate and articulate the clinical practices that ensure perioperative safety and quality and the professional practices that are expected from perioperative nurses.

The RMP ends on the 30 September 2021. Much work has been done in recent weeks to prepare the final drafts the ten PPSPNs and work is ongoing to incorporate the high-level evidence reports into early drafts of the nine safety and quality topics that will comprise the SSQCPEs.

ACORN eagerly awaits members' and subscribers' responses to the new structure of the PPSPNs and SSQCPEs. Feedback for the draft standards that have already been made available for public and member comment has been overwhelmingly supportive. In response to member requests ACORN is evaluating the possibility of adding a cross reference to the PPSPNs and SSQCPE which would enable users to quickly locate elements of interest across the entire collection. In addition, ACORN staff are also considering a new layout and revised features. These may include a map of the changes, revised crosswalks of how the PPSPNs and SSQCPEs relate to the National  Safety and Quality Health Service Standards, the Nursing and Midwifery Board of Australia Registration Standards and the Standards Australia standards that apply to the perioperative setting.

Development of the ACORN standards is a massive, complex, taxing but rewarding multi-year project. It requires the efforts of many, most of whom contribute voluntarily. As the sun sets on the RMP, ACORN remains so very grateful to all who have helped shape the 2022 New ACORN Standards. They will look and be different. The ACORN Standards are, and always will be, ACORN members’ standards and it is ACORN's hope that the New ACORN Standards will be embraced by perioperative nurses all over Australia.

The latest from the Roadmap Project was presented in a webinar by ACORN CEO Rebecca East, ACORN Standards Manager Cath Murphy and Roadmap Project National Leadership Group Chair Deb Thoms.

View the webinar

Since the last report, ACORN has continued to work closely with its member consultants and volunteers to further develop the Professional Practice Standards for Perioperative Nurses (PPSPNs) that will be published in May 2022.

On average, each PPSPN takes between 12 to 16 weeks from drafting to being ready for ACORN board review and approval, after revision, as necessary. This brief report provides an upper level overview of the stages and processes of each of the development stages.

The first stage is confirmation that a proposed standard aligns with the needs of Australia's perioperative nursing profession. For the 2022 PPSPNs this has involved discussion with and confirmation from the Professional Workstream Team (WST), in the first instance, and preliminary discussion with the National Leadership Group (NLG) to seek their views of how a specific standard sits within the context of the larger Australian nursing community and its relationship to relevant professional instruments such as those published by the Nursing and Midwifery Board of Australia (NMBA).

The second stage requires ACORN's Standards Manager to do a detailed review of related public policy and recently published research relating to the topic addressed in the draft standard. ACORN is fortunate to be currently working with an external consultant, Carollyn Williams, who has extensive experience and deep understanding of the historic and current professional and practice issues impacting perioperative nurses. To complement Carollyn's historical viewpoint and to ensure ACORN's eventual PPSPNs are future-proofed ACORN is fortunate to also have Michelle Hibberson, a mid-career, currently clinically-based perioperative nurse, who is working closely with Carollyn to ensure the PPSPNs meet the needs of current perioperative nurses and practice.

Once the drafts are finalised they are submitted to the Professional WST for a two-week review period. Changes suggested by the WST are further reviewed by the ACORN Standards Manager and, where needed, included before the next draft is provided to the NLG. The NLG also has a two-week review period. Their comments are subsequently reviewed and, where they improve the draft, edits made. The NLG Chair is further consulted and on their direction ACORN then provides the draft to members and key stakeholders for a one-month comment period. Comments from the public consultation are reviewed and discussed in detail with the standard writers, the WST and the NLG before the NLG finalises a draft for submission to the ACORN board for pre-approval consideration.   

Three PPSPNs are now almost ready for board consideration and five of the likely eight nursing role PPSPNS are almost progressed to the first WST review stage.  

This considerable body of work is proceeding in tandem with the drafting and review of 14 Standards for Safe and Quality Care in the Perioperative Environment (SSQCPEs). It is an exciting and highly productive phase of development for the ACORN Standards. All at ACORN are committed to bringing the best ever set of ACORN Standards to the profession. We believe this Standards milestone is a perfect fit with ACORN's ‘Moving to a golden future’ – the theme of the national conference scheduled for May 2022 on Queensland's Gold Coast. Until then it's time to keep on drafting, reviewing, producing and approving. Please follow our journey via ACORN's socials, its website and in carefully timed electronic direct mailouts.

During May, the Roadmap Project (RMP) has flourished, and the project is on course to finish on schedule with the RMP's National Leadership Group's (NLG) final meeting on 15 September 2021. We appreciate that the RMP’s work, undertaken from 2019 to 2021, has significantly underpinned the improvements in the ACORN Standards.

The Professional Workstream Team (WST) and the NLG have carefully considered the comments and suggestions collected from ACORN members' during the online feedback process for the Professional Practice Standards for Perioperative Nurses (PPSPN) – Registered Nurse. The RMP report in May detailed how the online feedback process offers ACORN members unique pre-publication insights into the recommendations of expert advisors and enables members to understand how ACORN advocates for perioperative nurses.

More than thirty ACORN members submitted feedback about the draft PPSPN – Registered Nurse. Overwhelmingly the feedback was positive. Several feedback items expressed gratitude for the preview and for ACORN's ongoing work to support and advocate for Australian perioperative nurses. Some of those thirty members suggested specific concepts, tools and value-adds that they believe can assist them with local implementation of this and other PPSPNs. ACORN is delighted to advise that it is currently considering the options for a suite of practical tools and resources that align with and complement the 2022 ACORN Standards.

The next edition of the ACORN Standards is scheduled for release in May 2022 at the ACORN conference, themed ‘Moving to a golden future’, on Queensland's Gold Coast. 

Please continue to check in with ACORN's social media accounts and our web page. We will soon be requesting member feedback on the drafs of PPSPN – Enrolled Nurse and PPSPN – Nurse Practitioner. Your feedback on these draft standards makes a significant difference, and moves perioperative nursing and ACORN to the ‘golden future’ they both deserve.

The RMP has forged ahead during these early days of the second quarter of 2021 and the resulting enthusiasm is palpable within ACORN and its membership. We are excited about receiving member feedback as the pre-publication drafts of the remaining Professional Practice Standards for Perioperative Nurses (PPSPNs) and the Standards for Safe and Quality Care in the Perioperative Environment (SSQCPEs) are made available over the coming months. The four workstream teams (WSTs) continue to make significant progress.

Business WST 

The Business WST continues to develop its launch plan. It is taking specific note of the existing data about subscription options and uptake by current subscribers so that future options are relevant and attractive to the perioperative community. The team has recently been trying to determine the number of operating theatres and procedure rooms in Australia. There does not appear to be a single source of valid and reliable information; however, ACORN's extrapolations and estimates suggest that there are between 3500 and 4000. ACORN's audacious goal is to have the ACORN Standards available and easily accessible to perioperative nurses in each of those. ACORN welcomes your views and feedback as to how we can best achieve that goal.

Clinical WST

In March, the RMP's National Leadership Group (NLG) accepted the Clinical WST's recommendations about the 14 SSQCPEs that will be part of the next edition of the ACORN Standards. In the weeks since then, ACORN has again engaged the Joanna Briggs Institute (JBI) to review the literature and prepare an evidence summary for each of the 14 topic areas. ACORN expects JBI to provide the complete set of summaries by October or November, after which time ACORN will draft the 14 new SSQCPEs. Subscribers may notice that 14 is far fewer than the number of standards in Volume 1: Clinical Standards of the current edition of the ACORN Standards. The reduction reflects the advice given to ACORN by the Clinical WST and the NLG to no longer develop and include ACORN standards when the issue is otherwise legislated or covered by a reputable organisation or agency such as the Australian Commission on Safety and Quality in Health Care, the National Health and Medical Research Council or Standards Australia. ACORN's intention is to avoid duplication, confusion and redundancy while focusing on other important issues, and ensuring clinical topics are addressed simply and easily located within ACORN's residual SSQCPEs.

Professional WST

Assisted by an external expert consultant the Professional WST has now completed drafts of separate PPSPNs for Registered nurses (RNs), Enrolled nurses (ENs) and Nurse Practitioners (NPs). The NLG has approved the draft RN PPSPN which is currently available online for stakeholder feedback until 4 May 2021.  

Research WST

The Research WST's work reviewing and interrogating research relating to best practices in standards development continues. Additionally, three senior members of the WST have volunteered to assist JBI with the preliminary scoping and search development for three of the SSQCPEs. The Research WST will also be invited to provide brief feedback to ACORN on the final JBI evidence summaries.

More than ever, ACORN appreciates the voluntary contributions of the members of the RMP workstream teams. Their unwavering commitment has meant that each of the teams are on track to complete their work, as scheduled, by 1 October 2021.

During March, the four workstream teams (WSTs) have made significant progress, overseen by the National Leadership Group (NLG).

Business WST 

In early March 2021 ACORN provided the Business WST with a comprehensive report of historic and current data relating to ACORN standards subscribers, subscription models, pricing and uptake by the target groups. The Business WST has plans for additional interrogation of that data so that the eventual subscription options they recommend to ACORN will be sensitive to members' needs and preferences. Those options also need to assist ACORN as it continues to pursue the primary goals of the Roadmap Project (RMP) which are to:

  • encourage the uptake of ACORN’s standards for perioperative nursing among hospitals across Australia
  • support perioperative nurses in the provision of high quality perioperative nursing care and the safe management of perioperative environments and procedures in Australia. 

Clinical WST

The NLG has approved the final list of Standards for Safe and Quality Care in the Perioperative Environment (SSQCPEs) submitted by the Clinical WST. The SSQCPE of the next edition of the ACORN Standards will include fourteen, perioperative clinical topics. This is substantially fewer than the number of clinical topics in the current and previous editions and reflects the advice of the Clinical WST to the NLG that responsibility for guidance for specific perioperative activities now rests with alternate expert agencies including the Australian Commission on Safety and Quality in Health Care, the National Health and Medical Research Council, federal and jurisdictional governments and Standards Australia. The Clinical WST's recommendations were thoughtful, balanced and future thinking. The team and ACORN very much look forward to members' and subscribers' feedback on the next edition of the ACORN Standards.

Professional WST

The NLG is currently reviewing the first of several Professional Practice Standards for Perioperative Nurses (PPSPNs) developed by the Professional WST. The team has finished drafting the Enrolled nurse PPSPN and the Registered nurse PPSPN and has engaged a small group of external perioperative nurse practitioners to assist with the drafting of the Nurse practitioner PPSPN. ACORN members should look forward to these new PPSPNs and, in particular, the inclusion of sets of unique ‘descriptors’. The descriptors provide examples of how a nurse would be expected to perform within the perioperative environment to meet the Nursing and Midwifery Board of Australia standards for practice. The descriptors are also exemplars of good practice. Perioperative nurses reviewing their practice in the future should do so against these descriptors. Practice review using the descriptors can support perioperative nurses by identifying gaps in practice and opportunities for learning. 

Research WST

The Research WST continue their comprehensive review of evidence regarding best practices in the development of standards. In addition Drs Duff, Gillespie, Murphy and Nicholson will also be working with ACORN and the Joanna Briggs Institute (JBI) to develop the research question using the PICO (population, intervention, comparison, outcome) framework and appropriate search terms  for the fourteen evidence summaries JBI is developing for ACORN. The Research WST has also kindly accepted a request from ACORN to briefly review each JBI evidence summary late in 2021.

The RMP's NLG remain fully committed to the RMP. Their individual and collective experience, diversity, knowledge and candour are invaluable to ACORN. Under the steadfast leadership of NLG Chair Deb Thoms, immediate past national Chief Nurse and Midwifery Officer, the NLG continues to advance the RMP and ACORN stakeholders should be excited as this major transformation of the historic ACORN Standards continues to evolve and take shape.

2021 finds the ACORN Roadmap Project (RMP) entering its next phase as each of the four Workstream Teams (WSTs) consolidate the processes which will result in their final recommendations to the RMP's National Leadership Group (NLG). This brief report provides a snapshot of each team's activities and progress to date.

The Business WST is currently developing a plan to launch the next edition of the ACORN Standards. In developing their launch plan and forecasting future uptake of the ACORN Standards, the Business WST requires significant background information about the current Standards subscribers, subscription models, pricing, format, access, use, feedback and user trends. In compiling data to inform the WST's discussions, ACORN notes an increasing trend away from individual subscriptions and a significant increase in institutional, multi-license subscriptions. The Business WST is also considering future opportunities for ACORN to grow the ACORN Standards's national footprint. In particular, with 2019 government data suggesting that the Australian nursing workforce includes 29 500 perioperative nurses, a key goal for the WST and the RMP is to increase the use of the ACORN Standards by every perioperative nurse in Australia. The difference between possible Standards users and actual users is vast, and ACORN is always appreciative of members referring their colleagues to the Standards.

The Clinical WST has just reached a significant milestone by providing the NLG with a series of individual recommendations regarding each current ACORN clinical standard's preferred future. More detail is available in the Standards update accompanying this RMP update.

The Professional WST has also begun a period of high productivity. The team is working with an expert ACORN member and fellow to align the ACORN Professional Standards to the Nursing Midwifery Board of Australia framework and standards. The first draft of the Registered Nurse standard is now ready for submission to the NLG. The team will next draft Enrolled Nurse and Nurse Practitioner standards. Each standard includes a series of new perioperative ‘descriptors’. The team anticipates that the descriptors match perioperative nurses' work.

The Research WST continues to progress their exhaustive review and interrogation of research relating to best practices in standards development. This information will assist the NLG as they review and refine draft standard operating protocols to provide part of the ACORN Standards future governance framework.

ACORN always respects and appreciates ACORN members' voluntary contributions and those of the many external experts contributing to the RMP. Their commitment never waivers, and together their separate pieces of work will ensure the validity, integrity, usability and uptake of the future ACORN Standards. We are excited about that future. You can follow its development along with us on ACORN's website, specifically at www.acorn.org.au/rmp.

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.