3 - Periop 101 Module Refresher for Nurses: A Quality Improvement Initiative

Description: This initiative was led by a multidisciplinary team at Seattle Children's Hospital, including OR Nursing Professional Development Practitioners, Nurse Managers, the Director and Associate Chief Nursing Officer of Perioperative Services, and OR Registered Nurses.

In Fall 2023, leadership identified variability in foundational perioperative practice across the OR team. Internal feedback, leadership observations, and E-feedback data indicated gaps in knowledge and inconsistent application of best practices. With a high percentage of novice nurses and concerns about preceptor readiness, leadership postponed onboarding new Periop 101-trained nurses. Instead, the department focused on reinforcing core perioperative competencies through a department-wide refresher using AORN's Periop 101 curriculum.

Historically, new-to-OR nurses were trained through a regional consortium which limited oversight of content consistency. On main campus 43% of nurses were trained through this model with an average of 2.4 years of experience. Concerns about practice readiness were observed and expressed by experienced staff, charge nurses, surgeons, and surgical technologists. While our Shared Governance Council had initiated a "Back to Basics" campaign targeting key safety topics, broader alignment with evidence-based practice was needed. With support from the ACNO, we obtained Periop 101 seats for all OR nurses to ensure a shared foundation rooted in AORN standards.

To pilot the process, Periop 101 modules were first assigned to surgery center nurses in spring 2024 to evaluate completion time and workflow integration. Nurses were encouraged to complete modules on-shift as an alternative to taking low census time. Main campus assignments began in October 2024. Staff were divided into three staggered groups with a 3 month completion window, and in total 73 nurses participated. The final exam was unproctored to provide flexibility for completion during shifts or from home using educational leave. Upon completion, a post-survey was distributed by the NPD team to gather feedback on perceived value, identified knowledge or practice gaps, learning outcomes, challenges encountered, overall impact on job readiness, and readiness for CNOR certification.

The post-survey had 25 responses. Notably, 44% of respondents identified knowledge or practice gaps in areas such as sterilization, time-based glove changes, patient positioning, and room turnover procedures. 60% of nurses reported learning something new. Time constraints and lack of quiet spaces to focus were noted as a barriers, and feedback from experienced nurses was mixed: some found the content too basic while others founds it dense. A common suggestion was to condense the material into a "refresher" format. Since implementation, a reduction in reported practice concerns has been observed, suggesting increased confidence and improved clinical awareness. Three nurses successfully passed the CNOR exam post-program, with others expressing increased motivation to pursue certification.

This initiative promoted consistent, evidence-based practice aligned with AORN standards and supported clinical growth across all experience levels. It improved staff readiness to precept, fostered professional development, and contributed to a stronger culture of safety. This model is replicable in other perioperative settings and can be adapted using AORN's Periop Mastery modules for a more streamlined approach.