Patient Safety

1
building
THE FOUNDATIONS
for patient SAFETY
collaboration
communication
education
Marking the Correct Surgery/Procedure Site
2
Overview of Presentation

• Patient safety initiative
• Practice model on marking the correct
  surgery/procedure site
• JCAHO focus on sentinel events- focus on
  wrong-site surgery
• Florida legislation- focus on wrong-site surgery

3
Patient Safety Initiative

• The Patient Safety Steering Committee is an
  interdisciplinary collaborative spearheaded by
  the FHA and includes 14 organizations. The
  Committee has taken a leadership role in
  providing guidance, direction and priorities
  related to initiatives related to patient safety,
  focusing on medical error.

4
Practice Model Guidelines

• The Patient Safety Steering Committee has
  developed four practice model guidelines in
  medication safety and one on marking the correct
  surgery/procedure site.
• These guidelines do not constitute the standard
  of care and are not intended to be the only
  practice methods for use.

Building Foundations
5
Practice Model Guidelines

• Developed so all hospitals would be able to
  implement them regardless of their size, level of
  automation, and location.
• Intended to be used by the health care team in a
  collaborative approach so that all aspects and
  caregivers are involved in the improvement
  process.
• These guidelines should be tailored to each
  organizations unique structure, policies, and
  resources so that the best results can be
  achieved.
• They are based on current literature and research
  related to the particular practice.

6
Marking the Correct Surgery/Procedure
SiteSurgeons Role

• The surgeon must be
• involved in the consent process
• note the correct site in his documentation
• consider having him co-sign the site, if
  possible.

7
Marking the Correct Surgery/Procedure
SitePatients Role

• Require the patient and/or patients family to be
  an active participant in identifying the
  appropriate surgical/procedure site.

8
Marking the Correct Surgery/Procedure
SiteMarking the Site

• Clearly mark either the correct side or the
  incorrect side with YES or NO.
• A clearly marked site should be used with
  indelible marking pen (e.g. Do not cut here or
  Do cut here).
• The use of an X is misleading as in does X mark
  the spot or does X indicate this is not the right
  site.
• Be sure patient is not allergic/sensitive to
  marking pen.

9
Marking the Correct Surgery/Procedure
SiteRecords/Documentation

• Have all relevant patient information available
  before surgery/procedure and ensure that all
  sources match with the same site. (Medical
  record, Xrays, tests, etc.)
• Patients chart, OR schedule, and consent form
  must all be in agreement and reviewed in Pre-op
  holding with patient/patients family.

10
Marking the Correct Surgery/Procedure
SiteRecords/Documentation

• Consider the use of a body diagram in
  documentation, clearly marking the correct
  surgical/procedure site.

Surgery Site Verification
11
Marking the Correct Surgery/Procedure
SiteVerification

• Require oral verification of the correct site in
  the OR/Procedure Room by ALL members of the team
  do not rely only on surgeon.
• Ensure that all members of the OR team can
  interrupt for verification check of proper site.

12
Marking the Correct Surgery/Procedure
SiteVerification

• In operating room, prior to prepping and draping,
  the anesthetist/anesthesiologist, surgeon,
  circulator and charge nurse re-verify proper
  site.
• Use a verification checklist.

13
Marking the Correct Surgery/Procedure SiteMonitor

• Have a monitoring system for verification
  procedures.

Surgery Site Verification
14
Marking the Correct Surgery/Procedure SiteJCAHO
Focus

• Organizations must now respond to suggestions in
  Sentinel Event Alerts within 45 days of
  publication.
• Organizations must consider suggestions as
  appropriate to their services and implement the
  suggestions or reasonable alternatives or provide
  a reasonable explanation for not implementing
  relevant changes.
• Sentinel Event Alert (8/28/98) addressed Wrong
  Site Surgery

15
Marking the Correct Surgery/Procedure SiteJCAHO
Focus

• Sentinel Event Alerts are now scored during
  surveys.
• Surveyor will assess familiarity with and use of
  Sentinel Event Alert information.
• Failure to comply will result in a type I
  recommendation.

16
Marking the Correct Surgery/Procedure SiteJCAHO
Focus
The intent of standard PI.4.2 will be changed to
read External sources are as up-to-date as
possible and include recent scientific, clinical,
and management literature, including relevant
Sentinel Event Alerts . . .."

17
Marking the Correct Surgery/Procedure Site2001
Legislation (CS/SB 1558)

• Requires hospitals and ambulatory surgery
  centers to implement and continually evaluate
  appropriate procedures, protocols and systems to
  accurately identify patients, planned procedures,
  and the correct surgery site in order to minimize
  the performance of wrong-site surgery, surgery on
  the wrong patient, wrong procedures or a
  procedure unrelated to the patients medical
  condition.

18
Marking the Correct Surgery/Procedure Site2001
Legislation (CS/SB 1558)

• Designates an adverse incident (wrong patient,
  wrong-site procedure, wrong procedure,
  unauthorized procedure or medically unnecessary
  procedure) as grounds for disciplinary action
  (Chapter 456). Patient preparation is
  specifically included in the scope of services
  subject to the provision.

19
Marking the Correct Surgery/Procedure Site2001
Legislation (CS/SB 1558)

• Designates leaving a foreign body in a patient,
  regardless of the intent of the practitioner, as
  a violation of the standard of care, not in the
  best interests of the patient and grounds for a
  disciplinary action (Chapter 456).

20
Key Learnings

• Wrong-site surgery still occurs despite awareness
  from health care organizations
• JCAHO has implemented standards for hospitals to
  implement suggestions on wrong-site surgery
  (Sentinel Event Alert)
• The 2001 Florida legislature enacted new laws and
  disciplines related to wrong-site surgery
• Models can promote safe practices

21
References/Resources

• Florida Patient Safety Steering Committee
  Practice Model for Marking the Correct
  Surgery/Procedure Site (www.fha.org)
• VHA Surgical Site Verification- The 7 Absolutes
• FHA Helpful Hints on Preventing Surgery on the
  Wrong Site (www.fha.org)
• JCAHO Sentinel Event Alert-August 28, 1998
  Lessons Learned Wrong Site Surgery
  (www.jcaho.org)

22
References/Resources

• American Academy of Orthopaedic Surgeons
  position statement
• Association of Operating Room Nurses
  (www.aorn.org)
• QRC Advisor 15(9), 6-8 Prevention of wrong-site
  surgery