Outfitting for the Outpatient Ortho Boom
Between aging Baby Boomers’ growing needs and a strong same-day preference among patients and insurers, the demand for outpatient orthopedic procedures like total knees and...
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By: Charlene DiNobile, Lisa Reed
Published: 10/2/2008
Any number of factors, from a lack of adequate pre-surgical planning to a failure to follow proper procedures, can result in a wrong-site surgery. Let's review the best practices for avoiding this devastating error.
Verify, mark, then verify again
The majority of wrong-site surgeries are caused by "a breakdown in communication between surgical team members and the patient and family," the Joint Commission stated in a December 2001 Sentinel Event Alert. To catch wrong-site errors before it's too late, you must develop clear, step-by-step procedures for verifying the correct surgical site both pre-operatively and intraoperatively. The Joint Commission's Universal Protocol, which provides specific recommendations for preventing wrong-site surgery, has been supported by more than 40 professional medical organizations. Based on that protocol, here's what we advise.
Next, it's the surgeon's turn to mark the surgical site while the patient is still awake and able to verify it. Using a permanent marker, the surgeon makes an unambiguous mark on the operative site, or the holding nurse draws a line on the correct site, and the surgeon then puts his mark on that line. The mark should be the surgeon's initials or the word "yes"; the letter X is not acceptable, since it's unclear whether it means "X marks the spot" or "avoid this side/site." The mark on the operative site should also be visible during prepping and draping of the patient. Before the patient is brought into the OR, the anesthesia personnel and circulator verify the site one more time.
The final step before the procedure can begin is the time out. All team members must stop what they're doing and verbally verify their agreement that the following information is correct: patient's name; procedure being performed; the surgeon doing the procedure; the site/side that will be operated on; radiographs; and any implants or special equipment needed. Designate one team member to document the names of all personnel present for the time out and verify that they've all participated. If there's no confusion about the patient's identity or the nature of the procedure, the team may then proceed.
Case closed
Wrong-site surgery is just not tolerated — not by patients, their families, healthcare providers or malpractice lawyers. The causes of wrong-site surgery — miscommunication, short cuts, carelessness, failure to follow procedure — shouldn't be tolerated either. Conduct regular audits of your surgical team using the Correct-site Surgery Audit Tool on page 36 to make sure everyone's doing their part to prevent this error. Continue to audit your staff periodically until you've got 100-percent compliance. OSM
Correct-site Surgery Audit Tool | ||
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Yes, No, N/A |
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Pre-op
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Operating Room
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On the Web |
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