The aim of this article is to provide guidance to perioperative practitioners on some of the legal and professional issues associated with their practice. It is anticipated that students and practitioners new to the perioperative environment will find this article can assist them in relating the issues discussed to their own practice. More experienced practitioners can refresh their knowledge of these issues.

Documentation and record keeping is an important aspect of healthcare practice and perioperative practice is no exception to this rule. For some time now, recording every activity or intervention that a patient receives has assisted with enhancing perioperative practice; equally, it has played a key part in resolving legal and professional incidents that have occurred. There are numerous national guidelines that uphold accurate record keeping as an intrinsic aspect to patient safety (DH 2006, HPC 2008, NMC 2008, Scottish Executive 2008, DH 2009). The intention of this article is to identify and discuss some of the more common errors associated with record keeping which may have a direct or indirect effect on practitioners' misconceptions of using electronic record systems.

Surgical gowning and gloving is an essential element of perioperative practice and is undertaken by the members of the anaesthetic and surgical teams involved in a perioperative intervention or procedure. Gowning and gloving will take place immediately after surgical hand antisepsis and the whole process is often referred to as scrubbing, gowning and gloving. Surgical hand antisepsis is defined as 'an extension of hand washing'(AfPP 2007), and 'the antiseptic surgical scrub or antiseptic hand rubs performed before donning sterile attire preoperatively'(AORN 2008). The aim of these processes is to improve the perioperative outcome of interventions and procedures by enhancing and further promoting aseptic techniques (ACORN 2006, AfPP 2007).

Hand hygiene has always been an important element of perioperative practice and is a topic that has gained even more importance in recent years for healthcare workers. In the mid 19th century Semmelweis first noted the link between hospital acquired diseases and hand hygiene (Semmelweis 1847, NATN 2000). More recently, it has been established that continuous effective hand hygiene can significantly decrease the transmission of microorganisms, thus reducing cross infection rates of many hospital acquired infections (Pratt et al 2007).

An essential component of any clinical intervention or clinically invasive procedure in the perioperative setting will involve the use of instruments. It is therefore essential that all practitioners in the perioperative setting are able to identify the instruments required for a case, for both preparation and checking purposes, be able to verify the sterility of the instrument and/or set, and be aware of the actions to be taken if any problems arise.

The blue line has appeared in the relevant window and a potential future perioperative practitioner is on the way. There are a number of issues and requirements which parents to be who are working in the perioperative environment should consider.

Many employers produce a staff handbook with information on a wide range of topics, including disciplinary and appeal procedures, which is given to employees at the start of their employment. For the majority of perioperative practitioners, the staff handbook will be kept in a safe place and not necessarily referred to during the course of their employment in the job, or indeed throughout their working life.

The incidence of pressure ulcers in the community and in acute settings is a concern for patients and healthcare professionals. The high cost to healthcare services of treating individuals with pressure ulcers means prevention is much cheaper than cure. Nurses have a responsibility to implement and participate in prevention programmes to decrease the incidence of pressure ulcers. Assessment is the first stage in prevention. This article focuses on the assessment of pressure areas, providing the reader with the knowledge of where and when skin assessment should take place and what needs to be assessed.

Preoperative evaluation of patients with renal dysfunction often requires the collaborative efforts of the primary care physician, nephrologist, surgeon, and anesthesiologist. Renal dysfunction is typically a spectrum of disease with multisystem effects. Optimization of preexisting medical issues is the key, as is a thorough understanding of the potential perioperative risks for further renal injury. Surgical or anesthetic techniques may require alteration for the patient with significant renal dysfunction. Identification of those at risk for renal injury may allow for preventative therapies in the perioperative period. This article focuses on defining the population at risk, a framework for preoperative evaluation, and developments in the area of perioperative renal protection.

This article focuses on the unique environment of the emergency department (ED) and the issues that place the provider at increased risk of liability actions. Patient care, quality, and safety should always be the primary focus of ED providers. However, the ED chart is the only lasting record of an ED visit, and attention must be paid to proper and accurate documentation. This article introduces the important aspects of ED documentation and communication, with specific focus on key areas of medico-legal risk, the advantages and disadvantages of the available types of ED medical records, the critical transition points of patient handoffs and changes of shift, and the ideal manner to craft effective discharge and follow-up instructions.

With the rapid growth in the field of pediatric sleep medicine, health care providers need to be aware of several emerging legal issues that have the potential of impacting their clinical practice. This article provides an overview of emerging legal areas that might impact the practice of pediatric sleep medicine, and discusses civil liability emerging from medical malpractice, issues that health care providers must be aware of including issues related to providing care for minors, and newer areas that relate to legal prosecution for health care fraud as it may relate to violations of quality of care.

The anterior approach to total hip arthroplasty (THA),when performed with the patient in the supine position,is enhanced by the use of a radiolucent, orthopedic table.This technique has numerous advantages: enhanced intraoperative fluoroscopy because of the patient's supine position on a radiolucent table, improved femoral exposure,and reduced soft tissue trauma. Criteria for patients election is not limited as it may be for other arthroplasty techniques.The role of the perioperative nurse during an anterior THA is to ensure optimal function of the orthopedic table and provide safe patient care. A clear understanding of the surgical techniques used and the functions of the table are imperative.

Preoperative evaluation of patients with renal dysfunction often requires the collaborative efforts of the primary care physician, nephrologist, surgeon, and anesthesiologist. Renal dysfunction is typically a spectrum of disease with multisystem effects. Optimization of preexisting medical issues is the key as is a thorough understanding of the potential perioperative risks for further renal injury. Surgical or anesthetic techniques may require alteration for the patient with significant renal dysfunction. Identification of those at risk for renal injury may allow for preventative therapies in the perioperative period. This article focuses on defining the population at risk, a framework for preoperative evaluation, and developments in the area of perioperative renal protection.

Differences in registered nurses'(RNs) perceptions of their work environment were measured with the Insel and Moos' Work Environment Scale to identify factors in the work environment that may influence retention. Statistically significant differences for perceptions of supervisor support and innovation were found between those RNs who left their unit or hospital during a 24-month period and those who stayed. Implementing strategies to promote retention of RNs to ensure safe, quality patient care is essential.

Injuries sustained from illicit drug use or alcohol intoxication are common in emergency departments. Ongoing assessments of psychosocial issues in trauma patients are imperative, even after the patient leaves the specialized area of the emergency department. Oftentimes, bedside nurses are ill prepared to identify the subtle clues of deeper psychosocial issues in complex patients such as trauma patients. This article focuses on the rationale for the development of a patient care standard to guide the bedside staff nurse in the care of the trauma patient. An example of a multiple trauma diagnosis-related patient care standard is presented.

This article focuses on the measurement of the social determinants of health, and specifically on issues relating to two key variables relevant to the analysis of public health information: poverty and inequality. Although the paper has been written from the perspective of economics, the discipline of the two authors, it is also of relevance to researchers in other disciplines. It is argued that there is a need to ensure that, when considering measurement in this largely neglected area of research, sufficient thought is given to the relationships that are being examined or assessed. We argue further that any attempt at measurement in this area must take into account the historical backdrop and the complex nature of the relationships between these key variables.

Significant developments in minimally invasive surgery (MIS) for the adult population have led to increased application of MIS techniques for pediatric patients. Laparoscopy is the most common MIS procedure used in pediatrics. Traditional surgical procedures that are now being performed laparoscopically include gastrostomy, pyloromyotomy, and repair of congenital diaphragmatic hernia and imperforate anus. All perioperative team members must be prepared to provide appropriately sized instruments and equipment to facilitate use of MIS techniques in the pediatric population and must ensure safe patient care to achieve optimal patient outcomes.