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Ensuring correct site surgery

AORN Journal, Nov, 2002 by Rita C. Scheidt

Marie asked herself repeatedly, "will life ever be the same again?" Jared, her seven-year-old son, had undergone surgery. It was supposed to be simple. They said he would be in and out of surgery in no time. Jared hurt his right knee last year. The physician applied a splint to Jared's knee; however, although it seemed to have healed, Jared continued to have problems walking, and the pain limited his mobility. The physician recommended surgery to repair the injury so Jared could walk better and live without pain. Being developmentally handicapped made Jared special, and raising Jared presented Marie and her family members with one challenge after another. Jared's limited verbal skills made communication with him particularly difficult. He was impulsive and his behavior was unpredictable.

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The decision to have the surgery was made after many weeks of considering the various treatment options. Marie and her husband planned carefully for the days and weeks after surgery. Normal recovery would tax family members, even under the best circumstances. Now, after surgery, Jared was even more physically handicapped. Why? When Jared had his surgery, they operated on the wrong knee and then had to operate on the injured knee also. Now, Jared and his family members were struggling with the incredible hardship of dealing with Jared's recuperation with two immobilized knee joints. Imagine the implications and consequences of an event that never should have happened--an event that was completely and totally preventable.

Though Marie's story is fictional, what if it were true? Unfortunately, such true stories do exist. Nurses, especially perioperative RNs, are in a unique position to help prevent such tragedies. Perioperative RNs must act as patient advocates to ensure that wrong site surgery does not happen. This article discusses the issue and demonstrates how to ensure correct site surgery.

A BRIEF HISTORY OF WRONG SITE SURGERY

There is no such thing as minor surgery, or so the saying goes. As an intervention, surgery never is simple because it is an insult to the integrity of the body. Since surgery was first performed, there have been complications. These complications may be due to the natural course of the disease process involved, the nature of the surgical intervention used, or unfortunate outcomes related to human error caused by a system failure. Often, the problem is a result of multiple small factors. When these small factors combine, an adverse event, such as wrong site surgery, occurs.

In 2000, the Institute of Medicine published To Err is Human: Building a Safer Health System, a report that focused on the high rate of medical errors in the United States. This report was a result of the Committee on Quality of Health Care in America's larger effort to address health care quality issues. (1) The report stunned the medical community and the public not only because of the high number of medical errors and the related financial cost, but also because of the unimaginable toll in pain, human suffering, and even death. Furthermore, the report led to many initiatives in government (eg, the Patient Safety Act), the health care industry, and the public domain to reduce the number of medical errors and make patient safety a primary goal.

Nurses play a key role in providing safe patient care. The American Nurses Association (ANA) states in the Code of Ethics for Nurses with Interpretive Statements says that "the nurse's primary commitment is to the patient, whether an individual, family, group, or community" and, "the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient." (2) These two statements summon every nurse to pay attention to, know, and adhere to the professional standards that define nursing practice. This includes knowing the provisions of their state's nurse practice act, relevant professional nursing standards (eg, AORN standards for perioperative nurses), and their implications for the practice of nursing.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines wrong site surgery as any surgery performed on the wrong site or patient or performing the wrong procedure. (3) To address the problem of medical errors, JCAHO introduced its sentinel event policy in 1996. This policy provides a mechanism for hospitals to self-report sentinel events, such as falls, patient injury or death in restraints, transfusion errors, anesthesia-related events, medical equipment errors, and wrong site surgeries. When a sentinel event occurs, it is subject to review under the JCAHO sentinel event policy, and this review includes a root cause analysis. The goals of such an analysis are to

* determine how the event happened,

* identify educational needs or goals,

* clarify what factors contributed to the event,

* discover risk factors, and

* determine how to prevent the event from occurring again.

This process also provides information necessary to initiate global changes in the delivery of health care to ensure positive patient outcomes.

Health Care Industry

Ensuring correct site surgery

AORN Journal, Nov, 2002 by Rita C. Scheidt

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