Verifying correct prosthesis use

AORN Journal, June, 2008 by Byron L. Burlingame

QUESTION: During a right total hip arthroplasty, the circulating nurse opened the prosthesis for the Left side and handed it to the scrub person. What steps should have been taken to verify the correct component was being placed on the sterile field?

ANSWER: Principles similar to the five principles of medication administration (ie, right patient, right time, right medication, right dose, right route) may be used for delivering components of the prosthesis to the sterile field. (1) The principles of implant component hand off would include, but are not limited to:

* correct patient;

* correct size;

* correct laterality;

* correct component (eg, femoral stem, ac etabular shell, bearing);

* correct type (eg, cemented versus non-cemented, angled versus straight, correct coating); and

* correct manufacturer.

The first opportunity to apply these principles is before bringing the patient to the room. The circulating nurse and scrub person should verify that the correct prostheses are present in the surgical suite.

The second occasion occurs when the presence of the correct components is verified during the surgical time out. At this time, the components should be present in the OR or in the prosthesis storage room (2,3) If the necessary components are not present, the surgeon must decide whether to stop the procedure until the correct component can be delivered to the OR or to continue the procedure. If the component can be delivered and verified before the point in the surgical procedure when it will be needed, the surgeon may decide to continue.

The third and final time to apply the principles is when the circulating nurse delivers the prosthesis to the sterile field. At this time, the circulating nurse should read all of the information from the box that identifies and differentiates the particular prosthesis. This information should be read to the surgeon directly from the box and verified by all scrubbed personnel before the circulating nurse opens the wrapper on the box. If possible, the surgeon should read the label from the box concurrently as the circulating nurse is reading it.

The circulating nurse should always be the person to deliver the prosthesis to the sterile field, not a health care industry representative. The role of the health care industry representative is to provide technical support and not to provide direct patient care. (4) In this situation, delivering an item to the sterile field is considered direct patient care.

The final opportunity occurs when the prosthesis is handed to the surgeon by the scrub person. The scrub person should read all of the information from the cover of the prosthesis sterile internal package before handing the prosthesis to the surgeon.

Editor's note: At various times throughout the year, the Recommended Practices Committee seeks review and comment on proposed recommended practices from members and other interested individuals. When available, these proposed recommended practices appear on AORN Online at http://www.aorn.org. Proposed recommended practice documents are available for review and comment for a 30-day period after they are posted. Interested individuals who do not have access to the Internet may obtain copies of the proposed documents by calling the Center for Nursing Practice at (800) 755-2676 x 334. A deadline for comments is indicated with each document. Please check these sources frequently to locate proposed recommended practices. All comments received are considered as the document is finalized. Thank you for your participation.

REFERENCES

(1.) AORN guidance statement: Safe medication practices in perioperative settings across the life span. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008:243-249.

(2.) O'Leary DS, Jacott WE. Mark my limb. Web M&M. December 2004. http://www.webmm.ahrq.gov/case .aspx?caseID=82. Accessed May 5, 2008.

(3.) Facts about the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery. http://www.jointcommission.org/Patient Safety/UniversalProtocol/up_facts.htm. Accessed May 5, 2008.

(4.) AORN guidance statement: The role of the health care industry representative in the perioperative setting. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008:180-182.

BYRON L. BURLINGAME

RN, BSN, NS, CNOR

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE