Newsletter

Wrong-Site Surgery: Impact of Practices

The Pennsylvania Patient Safety Authority  evaluated recent wrong site surgery reports to see which of their recommended safety practices would have had the most impact on preventing the events. In order from highest impact to lowest, the practices are:

Provider verifies. All information that should be used to support the correct patient, operation, and site, including the patient’s or family’s verbal understanding, should be verified by the nurse and surgeon before the patient enters the operating room (OR).

All engaged. All members of the operating team should verbally verify that their understanding matches the information in the relevant documents.

Reference mark. The site mark should be visible and referenced in the prepped and draped field during the time-out.

Voice concerns. Operating team members who have concerns should not agree to the information given in the time-out if their concerns have not been addressed.

Circulator verifies. All information that should be used to support the correct patient, operation, and site, including the patient’s or family’s verbal understanding, should be verified by the circulating nurse upon taking the patient to the OR.

Stop activities. All noncritical activities should stop during the time-out.

Confirm mark. The site should be marked by a healthcare professional familiar with the facility’s marking policy, with the accuracy confirmed both by all the relevant information and by an alert patient, or patient surrogate if the patient is a minor or mentally incapacitated.

Mark with provider’s initials. The site should be marked by the provider’s initials.

Site on history and physical. The correct operation and site should be noted on the record of the history and physical examination.

Time-out for each procedure. Separate formal time-outs should be done for separate procedures, including anesthetic blocks, with the person performing that procedure.

Site on schedule. The correct site of the operation should be specified when the procedure is scheduled.

Site on consent. The correct operation and site should be specified on the informed consent.

Active responses. Verification of information during the time-out should require an active communication of specific information, rather than a passive agreement, and be verified against the relevant documents.

Verify with images. Verification of spinal level, rib resection level, or ureter to be stented should require radiological confirmation, using a stable marker and readings, by both a radiologist and the surgeon.

Provider empowers. The surgeon should specifically encourage operating team members to speak up if concerned during the time-out.

Access office records. The surgeon should bring copies of supporting information uniquely found in the office records to the surgical facility the day of surgery.

Provider resolves discrepancies. Any discrepancies in the information should be resolved by the surgeon, based on primary sources of information, before the patient enters the OR.

Address concerns. Any concerns should be resolved by the surgeon, based on primary sources of information, to the satisfaction of all members of the operating team before proceeding.

Reconcile discrepancies. Anyone reviewing the schedule, consent, history and physical examination, or reports documenting the diagnosis, should check for discrepancies among all those parts of the patient’s record and reconcile any discrepancies with the surgeon when noted.

Ask active questions. All verbal verification should be done using questions that require an active response of specific information, rather than a passive agreement.

Two identifiers. Patient identification should always require two unique patient identifiers.

See http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2011/sep8(3)/Pages/109.aspx for more information.