Ensuring correct site surgery

AORN Journal,  Nov, 2002  by Rita C. Scheidt

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Patients with more complex needs, such as older adults who suffer from comorbid conditions or dementia or patients with florid psychiatric conditions, may be unable to actively participate in their care or the verification of the correct surgical site. Patients with hearing and vision impairments also present a communication challenge. The perioperative RN has a professional responsibility to thoroughly assess and plan for patients with complex needs. Including family members and patients' caregivers contributes to patient safety. When patients' primary language is not English, RNs should use interpreters and should not depend on patients' family members because they also may have a language barrier. Most facilities have resources that can be accessed to ensure that patients have every opportunity to communicate accurately and clearly.

A patient who is morbidly obese poses a unique dilemma and treatment challenge in the OR. The patient may require specialized management, a suitable OR bed, special retractors, and extra long instrumentation. The size of the patient can serve as a distraction to even well-intentioned staff members and lead to wrong site surgery or other types of medical errors.

Some facilities may use multiple-procedure consents. This practice attempts to save time by directing the patient to cross out every procedure except the one for which he or she is scheduled. This method is used on the pretense of saving time, but it opens the door to errors and the opportunity for mistakes. The patient may not understand medical terminology or the procedures they are crossing off the permit. What if a procedure is not crossed off and this results in the patient undergoing unnecessary surgery? This is an example of a system that focuses on efficiency and not patient safety. When errors happen, they often are initiated with a small, seemingly insignificant error in judgment that then precipitates other actions resulting in often tragic consequences.

The Joint Commission identifies unusual set-ups or equipment in the OR as a factor contributing to wrong site surgery. For example, orthopedic surgery usually is performed in a specific room in the OR, but as a result of unanticipated events, the orthopedic surgeon must perform his or her procedure in another room. The alternate room is smaller, the anesthesia column is in a different place, and the surgeon wants to use alternative power equipment that is new to perioperative staff members. Perioperative staff members must arrange the room properly and be aware that changing rooms may be disorienting. When the OR is in a state of chaos, the possibility of error increases, and staff members must remain aware and vigilant to protect the patient from negative outcomes.

Many of the contributing factors listed previously address situations that easily could be remedied. Adhering to the following actions consistently helps ensure correct site surgery.

* Engage in ongoing and effective communication with members of the surgical team.