Wrong-site surgery (WSS) is a rare but preventable sentinel event with significant patient, professional, and organizational consequences. Despite longstanding safety standards, including the Universal Protocol, WSS continues to occur across procedural settings. This case report examines a wrong-side nerve block that occurred during a nonemergent orthopedic procedure. The case is discussed in the context of known patterns, contributing factors, and system failures associated with WSS. Key issues identified include deviations from established workflows, communication gaps, interruptions, incomplete verification of laterality, and failures to consistently apply policies and procedures at critical points in care. Although elements of the verification process were completed, the case highlights vulnerabilities in execution and timing, particularly before the initiation of a nerve block. Implications for perioperative nursing practice emphasize adherence to standardized processes, vigilance during workflow changes, effective team communication, and proactive system-level safeguards to reduce the ongoing risk of WSS.

Perioperative nurses use evidence-based practice to achieve optimal outcomes when caring for patients. Translating evidence-based guidelines into practice, however, can be difficult, especially when barriers to compliance are present. Compliance barriers may arise from organizational culture, knowledge deficits, absence of policy, shortcuts, competing priorities, time constraints, physician pushback, or system-level barriers. When evidence-based practices are not followed, patient safety events and suboptimal outcomes may occur. This article addresses how legislative advocacy and policy provide solutions when barriers prevent full compliance or efforts fail. Even with organizational policy solutions, barriers to implementation may still exist. Perioperative nurses should therefore advocate in policy arenas to promote change that results in optimal quality and safety outcomes for themselves, their team, and their patients. Compliance, barriers, and advocacy are explored to navigate the intersections of policy, quality, and safety.

Surgical smoke generated by energy-based devices is a recognized occupational hazard in ORs, containing toxic gases, particulate matter, and potentially viable cells. Exposure can lead to negative consequences. Research shows perioperative nurses are reporting twice the incidence of respiratory problems as compared to the general population. Despite increasing evidence of harm, evacuation of surgical smoke remains inconsistent across health care settings. Barriers to compliance include the lack of formal education on smoke hazards and evacuation equipment. Effective strategies to improve compliance with evacuation guidelines include conducting a gap analysis, creating and implementing an intervention plan, education and training on evacuation, and ensuring leadership support and participation. Other considerations to compliance involve the organizational culture, engaging perioperative nurses in changing practices, promoting legislation on smoke evacuation, and applying budgetary efficiencies. Addressing surgical smoke through evidence-based research and sustained compliance is essential to protecting the health and safety of perioperative personnel.

Surgical care is becoming more complex, and hospitals are under amplified pressure to improve quality and prevent harm. Ongoing sentinel events, such as wrong-site surgery and retained surgical items, indicate that important safety errors persist and require system-level solutions. Doctor of nursing practice (DNP)-prepared perioperative nurses are well positioned to lead system-level improvements by using evidence-based practice, quality improvement, and implementation science to translate research into practice and develop sustainable improvements over time. This article describes how DNP-prepared perioperative nurses lead and strengthen safety and quality initiatives in the perioperative practice setting. This article applies The Essentials: Core Competencies for Professional Nursing Education by the American Association of Colleges of Nursing, with a focus on Domain 5 (Quality and Safety), to connect DNP scholarly project work to measurable perioperative safety outcomes. Practical guidance is provided to support alignment of DNP-led scholarly projects with the strategic priorities of the organization.

Quantitative blood loss (QBL) measurement is an evidence-based standard in obstetrics that improves detection and management of postpartum hemorrhage, replacing traditional visual estimation of blood loss. Extending QBL to intraoperative care may improve patient safety, as inaccurate blood-loss estimation can delay hemorrhage recognition, lead to inappropriate transfusion, and increase preventable morbidity. This clinical review outlines strategies for implementing QBL as an intraoperative standard. Successful adoption requires a structured, multidisciplinary approach, including standardized measurement methods, appropriate technology selection, defined team roles, integration into operative workflows, staff training, and ongoing audit and feedback. Integration with patient blood management strategies further supports timely and appropriate responses to bleeding. Broader application of QBL across surgical specialties may enhance clinical decision-making, resource utilization, and patient outcomes.