Documentation of the lateral position

AORN Journal,  Nov, 2007  by Bonnie Denholm

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QUESTION: Recently, we performed a chart audit and discovered inconsistencies in the way perioperative team members are charting the lateral position. Is there a standard way to document the lateral position? Is there a risk for wrong site surgery if we are not consistent in our documentation?

ANSWER: Clarity about the definitions of positions is important for safe patient care. Communication breakdown is one of the most common reasons cited by the Joint Commission as a contributing factor for wrong site surgery? It is especially important to be clear about how the lateral position is being defined and to confirm the laterality of the procedure before positioning the patient. If the patient is positioned on the wrong side, the risk of performing the procedure on the wrong side is dramatically increased.

In a lateral position, the patient is positioned on the nonoperative side. The dependent side is the reference point for documentation. For example, in the right lateral position, the patient is lying on the right side, providing exposure for a leftsided procedure (eg, upper chest or kidney procedure). In the left lateral position, the patient lies on the left side, which provides exposure for a surgical or invasive procedure on the patient's right side. (2-4)

When documenting, it is important to be consistent between the operative record, anesthesia record, and the surgeon's dictation. A multidisciplinary meeting may be necessary to establish a policy for documenting the lateral position to attain consistency and standardization in documentation throughout the health care organization.

Standardized documentation for positioning is important for postoperative assessments and communications throughout the patient's care. When the patient has been in the lateral position for an extended amount of time during an invasive procedure, it is crucial that the nurses caring for the patient postoperatively carefully Inspect the areas that are at high risk for pressure Injuries. Clear documentation will provide guidance for effectively changing the patient's position postoperatively to avoid recurring pressure on the high-risk areas. (5)

According to AORN's "Position statement on patient safety," accidents and errors may result from a combination of flawed systems or processes and active failures by direct care providers in the clinical setting. (6) The position statement lists several factors that contribute to surgical errors, including inadequate communication among team members. Strategies to reduce errors include:

* incorporating standardization and

* error proofing processes,

* developing policies and procedures

* that address unsafe practices,

* participating in quality and process improvement initiatives, and

* educating employees about the potential for errors and how to avoid them. (6,7)

AORN's "Position statement on correct site surgery" states that the perioperative team should develop procedures and protocols collaboratively in multidisciplinary teams to achieve a comprehensive approach to preventing wrong site surgery in each health care delivery system. (8) Multidisciplinary teams should include perioperative RNs, surgeons, anesthesia care providers, risk managers, and other health care professionals. Establishing a common definition for how the lateral position will be documented on all records relating to the perioperative team will contribute to the effort to decrease the risk for incorrect positioning and will help to improve communication in all phases of the patient's care.

REFERENCES

(1.) Joint Commission on Accreditation of Healthcare Organizations. A follow-up review of wrong site surgery. It Comm Perspect. 2002;22(1):10-11.

(2.) Heizenroth PA. Positioning the patient for surgery. In: Rothrock JC, ed. Alexander's Care of the Patient in Surgery. 13th ed. St Louis, MO: Mosby/ Elsevier; 2007:155.

(3.) Phillips N. Positioning, prepping, and draping the patient. In: Berry and Kohn's Operating Room Technique. 11th ed. St Louis, MO: Mosby/Elsevier; 2007:511.

(4.) O'Connell MP. Positioning impact on the surgical patient. Nurs Clin North Am. 2006;41(2):173-192.

(5.) Defloor T, De Schuijmer JD. Preventing pressure ulcers: an evaluation of four operating-table mattresses. Appl Nurs Research. 2000;13(3):134-141.

(6.) AORN position statement on patient safety. In: Standards, Recommended Practices, and Guidelines. Denver, CO: AORN, Inc; 2007:398-400.

(7.) Beyea SC. Accident prevention in surgical settings--keeping patients safe [Research Corner]. AORN J. 2002;75(2):361-363.

(8.) AORN position statement on correct site surgery. In: Standards, Recommended Practices, and Guidelines. Denver, CO: AORN, Inc; 2007:371-374.

BONNIE DENHOLM

RN, MS, CNOR

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE

COPYRIGHT 2007 Association of Operating Room Nurses, Inc.
COPYRIGHT 2008 Gale, Cengage Learning