The Oak November 2025
Welcome to the November issue of The Oak.
With Perioperative Nurses Week , conference registrations open, the new strategic plan, the conference educational program and fruitful collaborations – there’s a lot happening at ACORN.
Over the last four weeks we have been finalising the draft of our new strategic plan. A summary of the plan will soon be available for members on our website. We invite comments and suggestions so the final plan can focus on areas that our members feel are important.
Recently I met with the Royal Australasian College of Surgeons (RACS) and informed them of ACORN’s activities. RACs are very keen to support us, and we will be discussing some collaborative projects with them soon.
This month, we will commence working with Advanced Pharmacy Australia (AdPha) to develop a perioperative medication resource to guide perioperative professionals on the management of medications pre-, intra- and post-operatively. Educational resources for patients will be developed as well. This is a two-year project, funded by the Department of Health and Ageing.
We have been very excited to see the number of abstracts received for our conference next year. We have reviewed all the submissions and a draft program will be released soon. There are some amazing projects going on out there!
Perioperative Nurses Week (PNW) is next week, from 9 to 15 November. This year’s theme is STARS of perioperative nursing, so I hope you are all getting ready to celebrate how wonderful you are. PNW is the time to take a moment and reflect on what a positive impact you have on the wellbeing of those that you care for each day. The ACORN board and staff would like to thank you for your dedication and commitment to the profession and the differences you make to people’s lives.
Take care, we can’t wait to see all the photos from the amazing PNW celebrations across the country.
President
It is an exciting time at ACORN as we continue shaping the next iteration of the ACORN Standards. The current public consultation process is underway via the ACORN website, and we are encouraged by the significant and constructive feedback already received. We look forward to ongoing engagement across the remainder of the consultation period.
Each draft standard is available for review for six weeks, and we warmly invite all members of the multidisciplinary perioperative community, as well as end-point consumers, patients and those with lived experience, to contribute. We encourage you to share your perspective – together, we can ensure these standards are the strongest and most evidence-based they can be.
Current drafts open for public consultation:
- Electrosurgical safety
- Sharps and preventing sharps-related injury
- Patient positioning and manual handling
- Surgical plume
- Latex and chlorhexidine sensitivity
- Laser safety.
Behind the scenes, our workstream teams are diligently drafting the remaining evidence summaries and standards. These are progressing well, and it is truly exciting to watch this next iteration of evidence-based standards come to life.
Thank you to all who are contributing your expertise, perspectives and ideas. Together, we are building the most evidence-based and implementable standards ACORN has ever produced.
Dr Toni Hains OAM, Catherine Smith
Daiane Gabiatti, Samia Hussein Barakat, Elaine Barros Ferreira, Karina Dal Sasso Mendes, Cristina Maria Galvão , Bruna Nogueira Santos, Renata Cristina de Campos Pereira Silveira
Research
Surgical time-outs: Ritual or real safety practice?
The surgical time-out, a core component of the WHO Surgical Safety Checklist, was introduced to prevent wrong-site surgery, patient misidentification, and other critical perioperative errors. While its theoretical effectiveness is supported by global data, recent evidence suggests that in many operating rooms, the practice has devolved into a symbolic and perfunctory routine. This commentary explores the gap between intention and real-world implementation, and offers practical, evidence-based strategies to reestablish the time-out as a meaningful safeguard in surgical care.
Compared with conventional nursing, the combined application of mindfulness-based motivational care during the perioperative period can more effectively promote postoperative recovery in patients with endometriosis, improve sleep quality and pain management, reduce negative emotions, enhance comfort, and improve quality of life.
In an important patient-level analysis of two randomised controlled trials published in the British Journal of Anaesthesia, hypocapnia, as reflected by low end-tidal carbon dioxide (ETCO2) during surgery was associated with worse outcomes than normocapnia, with higher rates of postoperative pulmonary complications (PPCs). The results can be used by anaesthesiologists in the operating theatre to reduce the occurrence of PPCs by carefully determining ventilatory settings to avoid overventilation in patients, and by considering cardiopulmonary interactions. This involves reducing tidal volume and respiratory rate as far as possible while aiming for a normal-to-high ETCO2 (optimal cutoff to be determined). Previous trials assessing mechanical ventilation settings in the operating room have produced conflicting results. The answer might lie in the objective of ETCO2 monitoring, as a surrogate of partial pressure of carbon dioxide (PaCO2), which is strongly associated with mechanical power through ventilatory settings.
According to the findings of this study, educational centres and universities can use the surgical preference card as a valuable educational tool to manage students’ anxiety and enhance their proficiency in performing clinical skills in the operating room.
Evidence suggests that consent forms are often signed by patients who are not fully informed. For First Nations people, this is aggravated by language barriers, culturally different understanding of health and racism leading to coercion. Better assessment of informed consent processes with First Nations people, training and ongoing quality improvement are required to identify and address gaps. Partnership with First Nations people is required to enhance current guidelines and to develop strategies to ensure true informed consent.
Enhanced recovery after surgery-guided nursing improves gastrointestinal function, reduces pain, and accelerates functional recovery in ACDF patients without increasing complications. This interdisciplinary approach enhances perioperative care efficiency and supports patient-centred outcomes.
Perioperative cardiac arrest: A rare event worth measuring
Perioperative cardiac arrest remains a rare but devastating event, particularly among emergency surgery patients. Work by Anezaki and colleagues confirms that emergency and elective populations represent distinct patient groups requiring different care pathways. Anaesthetists should consider patient- and procedure-level factors to anticipate and mitigate risk, while embracing upstream prevention and strengthening perioperative systems. Healthcare systems must focus on reducing variation in care between institutions to improve overall outcomes.
Standardised perioperative protocols and variance in pediatric surgery
In this cohort study of 1081 pediatric surgery patients, complication rates remained unchanged while total hospital costs and hospital length of stay decreased significantly following protocol implementation.
In this randomised clinical trial including 3247 adults undergoing elective noncardiac surgery, targeting a mean atrial pressure of at least 70 mm Hg for patients at low risk, at least 80 mm Hg for those at intermediate risk, and at least 90 mm Hg for those at high risk of intraoperative hypotension did not improve postoperative disability at 6 months as measured by the World Health Organization Disability Assessment Schedule (range, 0 to 100; minimal clinically important difference, 5 percentage points) compared with usual intraoperative management that aimed to maintain a mean arterial pressure of at least 65 mm Hg at the discretion of the treating anesthesiologist (mean score, 17.7 vs 18.2, respectively).
In this randomised clinical trial that included 1272 participants, the incidence of a composite primary outcome (acute kidney injury, acute myocardial injury, nonfatal cardiac arrest or death within the first seven post-operative days) was not significantly different between patients assigned to individualised MAP targets and patients assigned to routine blood pressure management with a MAP target of 65 mm Hg or higher.
Articles
Hidden variable in hand hygiene: Why dose size, standards and technology matter
Hand hygiene remains the cornerstone of infection prevention, but the conversation often stops at when to clean hands rather than how much product is needed. For infection preventionists (IPs) and health care leaders, overlooking the critical factor of dose size risks undermining adherence, workflow and, ultimately, patient safety
ATP testing in health care: What it can and cannot tell us
Measuring the effectiveness of cleaning and disinfection remains one of the most critical yet persistent challenges in health care today. Tools such as fluorescent markers and adenosine triphosphate (ATP) testing are often adopted to provide quick, quantifiable insights into environmental hygiene. However, while these methods can support staff training and quality improvement, their results are frequently misunderstood – and sometimes misused – as indicators of microbial contamination or disinfectant performance. Understanding what these tools measure and their inherent limitations is critical for applying them appropriately in health care settings.
Documents of note
HPU 190 Sterilizing Services and Endoscope Reprocessing Units (Revision 8.0, October 2025)
Innovations and initiatives
National Clinical Audit of Perioperative Care (NCAPC) The Royal College of Anaesthetists (UK)
The National Clinical Audit of Perioperative Care (NCAPC) is a newly commissioned national audit which is being established to assess the quality and safety of perioperative services – encompassing pre-operative, intra-operative and post-operative care – across NHS settings in England and Jersey.
New National Framework for Measuring Quality in Perioperative Care Centre for Perioperative Care (UK)
The framework, informed by robust evidence and extensive stakeholder engagement – including patients, clinicians and policymakers – provides a consistent, practical approach to evaluating perioperative care across the UK.
Nurse staffing as a national performance goal The Joint Commission (USA)
Starting in 2026, The Joint Commission will formally recognise nurse staffing as a national performance goal, meaning hospitals seeking accreditation must meet certain standards related to staffing and oversight. Under the new element of performance, known as Goal 12, healthcare organisations must have a nurse executive responsible for overseeing staffing policies and procedures. The goal stipulates that hospitals have a registered nurse on duty to either directly provide care or supervise nursing services provided by other staff 24/7. This marks the first time the organisation has included nurse staffing as a core component of quality.
NSW OTA Professional education day
8 November 2025, Wollongong
ACORN 2026 Conference
14–16 May 2026, Brisbane Convention Centre
Papua New Guinea Perioperative Nurses Society (PNGPNS) Conference
Registrations now open and education program available
ACORN is thrilled to announce that registrations are now open for the 2026 ACORN Conference.
We have been delighted by the number and quality of abstract submissions received and have created a dynamic and diverse conference program.
The conference theme, Building Bridges: Strengthening collaborative perioperative care, highlights the vital role of teamwork and partnership in the perioperative setting. It underscores the importance of forging strong connections – both within our professional community and beyond – to enhance patient care, share knowledge and drive innovation together.
We look forward to seeing you in Brisbane!
ACORN 2026 International Conference
14–16 May 2026
Brisbane Convention Centre, Brisbane