Internal monitoring of staff compliance to the Universal Protocol prompted us to develop a video for re-educating staff on wrong-site surgery. The 14-minute movie (www.outpatientsurgery.net/videos) shows our staff in action as they confirm a patient's identity, procedure and surgical site by following a script for how we want that info checked and rechecked before surgery. Here are the 3 major components of wrong-site surgery prevention that we covered in the video.

Pre-procedure verification
An office employee — most likely the receptionist — greets the patient and family members. The pre-procedure verification begins by making copies of the patient's photo identification and insurance cards.

• During registration, confirm the patient's identification and pertinent demographic information. Have the patient spell her full name, verify her home address, date of birth, home phone number, occupation, insurance carrier and Social Security number. We found that asking a patient to confirm her name when it's read aloud with a simple "yes" created too many opportunities for confusion (especially with our non-English speaking patients). Also ask her to confirm the surgeon she's there to see, as well as the procedure type and location. After verbal confirmation of this information, place a wristband on the patient's left wrist that notes her name, date of birth, age, sex, date of service, physician's name, your facility's name, the patient identification number and patient's account number.
• In pre-op, a nurse greets the patient and friend or family member in the waiting area, asking the patient to state her name and date of birth as she's escorted back. If the patient is unable to communicate with the nurse, a family member or friend may do so for her. The nurse compares this information to what's written on the patient's chart and ID bracelet. Also ask the patient what procedure she's there to have done, verifying the surgery's intended side and site. The nurse compares this information to the consent, history and physical, and OR schedule. Address any discrepancies or missing information before moving forward.
• The anesthesia provider repeats the verification process with the patient or, if necessary, the patient's family. He asks the patient to state her name, date of birth, the operating surgeon and the procedure for which she's scheduled, including the site and side. Again, that information is compared to the patient's chart and wristband.

Site marking
The surgeon must identify, verify and mark the surgical site.

• He begins by asking the patient to state her full name, date of birth and the procedure she's about to have done. After confirming that information against the patient's chart, the surgeon must make an unambiguous mark at or near the intended surgical site. It must be sufficiently permanent to be visible after skin prepping and draping. The surgeon marks "Yes" at the intended site.
• Take the patient into the OR, introduce her to the surgical team and have her again state her full name, date of birth and the scheduled procedure, which the circulating nurse will check against the patient's chart and wristband. The circulating nurse will also confirm that the surgeon has marked the correct site. It's key to have the patient actively involved in this verification process. Before anesthesia induction, the provider confirms with the circulating nurse that all documentation is complete and reconciled.

Time out
According to the Joint Commission, the pre-procedure time out should serve as a final confirmation of the correct patient, site and procedure.

• Initiate the time out, which should include active communication and engagement among all members of the surgical team. Announce the patient's name, the surgeon's name, the scheduled procedure, that all documentation is complete and confirm that the correct site is marked and visible to each member of the team.
• Address additional safety issues, including alcohol skin prep precautions and proper patient positioning, and confirm the delivery of pre-op antibiotics.
• Ask if anyone has concerns. The procedure should not start until all questions are addressed and resolved and each member of the surgical team verbally agrees that it is safe to proceed.

Role models
We noted inconsistencies in our compliance to the Universal Protocol's components. The verification process acted out in our movie is designed to enhance staff knowledge and correct those inconsistencies so that we perform a safe surgery each and every time. This process is effective only if each member of the patient-care team takes an active role in confirming the accuracy of the patient's identity and information and speaks up if anything seems amiss. Each member of the clinical team should feel empowered to report actions that may harm the patient without fear of retribution. As the Joint Commission states: Wrong-person, wrong-site and wrong-procedure surgery can and must be prevented.

The actors (members of our staff) we used incorporated key phrases or critical aspects of the procedure- and patient-verification process, but the movie is effective because the action felt natural and reflected how staff and patients actually interact in our facility. After watching the video, everyone in our center — from the receptionist to the surgical nurses — sees exactly how we want staff to verify the correct procedure at the correct site on the correct patient. Now there's no confusion.