When you consider how many ORs besides yours that many of your surgeons operate in nowadays, it's easy to see why standardizing something as simple as how the surgical site is marked can be a real challenge. Some facilities ask surgeons to mark the site by signing their name, others by marking it with a "yes." Wouldn't it make sense to reduce the opportunity for mistakes by standardizing marking protocols? The hospitals and surgery centers in the St. Cloud, Minn., area came together to make certain that this important safety step is handled the same way every time.

Creating a safety society
Our idea was to create a safety society. The first call went to my facility's medical executive committee to make sure they were on board with my efforts. They were supportive from the start and provided me with a list of facilities frequented by our surgeons. Working off that list, I placed phone calls to each facility's OR manager, inviting her to a meeting to discuss standardized surgical site markings. We targeted clinical managers, not administrators, because we wanted individuals who worked on the front line and had the influence to enact change at their facilities.

The interest and turnout exceeded my expectations. We discussed the possibility of each facility using the same wrong-site surgery prevention protocol. Based on research, I proposed requiring surgeons to sign their initials to the correct site with verbal confirmation by the patient. The members discussed that potential and brought back the new system to their respective facilities.

Change is difficult, especially for surgeons with defined routines. To ease the transition in our facility, we sent letters to each surgeon, advising them of the impending change to the site-marking requirements. On the day of surgery, we posted staff managers in the OR corridor. They were there to baby-sit surgeons; literally putting markers in their hands before leading them to the patients they needed to mark. The managers worked for about a month to retrain the approximately 100 surgeons with whom we work.

Involving patients
We also realized that patients needed to be better educated about the importance of their roles in confirming the correct surgical sites. Our group decided to participate in a health fair at a local mall to discuss wrong-site surgery, among other surgical safety topics. Despite the fact that we're an unofficial organization with no solid member list or revenue from dues, we printed safety brochures and manned the booth with volunteers for two 12-hour shifts over two days.

That's an example of the commitment to our cause from a completely volunteer, grassroots force. Here are a few reasons for that dedication:

• It's easy. Our safety society meets monthly, at 4 p.m. on the first Tuesday of each month. We chose that day and time because our local AORN chapter meets at 6 p.m. on the same day, in the same town. This means that participants can easily attend both meetings by dedicating just one night each month to the cause. Those traveling great distances also find it easier to hit two meetings before returning home. We provide dinner — Sloppy Joes and potato salad was a recent favorite — and place a basket on the table for donations to cover the food costs.
• Expert advice. Perhaps the biggest benefit from being part of this informal society occurs between the monthly meetings. Attendees exchange e-mail addresses and remain in constant contact. A manager often sends a group e-mail asking for feedback from us about how to handle certain safety concerns. The request sparks a creative exchange of ideas from several expert perspectives. Some days, the e-mail chatter is significant. I save the e-mail strings in a word processing document for future reference.
• Power in numbers. Our society, while having no official power, has developed into a de facto authority for safety protocols in our area. A surgeon might ask, "Why are we changing surgery site marking protocols?" The answer, "because our region's clinical leaders decided it will improve our safety record," carries significant weight and serves to empower clinical managers. Having people united to make a difference for the patients in our community, in spite of the fact that we are competitors, gives life to the organization.

Standing room only
Our safety society continues to be a great success. I originally expected to meet as a group once or twice, but interest in our gatherings continued to grow through word of mouth. Today, our monthly meetings are packed with managers from 16 hospitals and surgery centers, including one die-hard who travels more than two hours to attend. Putting patient safety at the center of our group's vision bonds us. It's been a wonderfully rewarding experience.