Correct Site Surgery Research Articles

Patients’ Perceptions of Importance for Self-Administered Correct Site Surgery Checklist: A Multisite Study

PurposeThe purpose of this study was to describe and validate the association between patient's self-administered correct site checklist and perceptions of importance for safe surgery. DesignA multisite nonexperimental, quantitative, descriptive study. MethodsA convenience sample of 173 adult patients from four different geographical multisite hospitals was included in the study. Inclusion criteria were age 18 to 75 years old, scheduled for surgery/procedure with laterality and ability to follow instructions. After IRB approval, investigators explained the purpose of the study, process and obtained consent from willing participants. Participants with clinical or behavioral limitations were excluded from the study. Participants completed a 24 item survey before and during surgery using a four-point Likert scale from one (not important) to four (extremely important). Descriptive data was analyzed using means, standard deviations, and percentage. All data was summarized and analyzed with STATA 12. FindingsMost of the participants perceived the importance of the survey checklist items positively implying that the active engagement is an important role for safe surgery. However, a few participants reported some of the items as not important/somewhat important: “It is on my left or right side” (6.9%); “surgery on my: (state your limb) and (right or left site) (1.9-3%); “check electronic access or copy of imaging with correct name and site” (14.9%); “state your name and birthday” (4%), “check correct ID bracelet information” (2.9%) and “believe in having an active role in preventing error” (2.3%). Some participants responded, “My surgeon knows it or surgery has been scheduled”. Findings indicated that even though the importance of correct site surgery is critical for patient's surgery, a few patients reported it as noncritical and relied on healthcare team for their safety. ConclusionsThis study validated the importance of the patients’ perceived roles in promoting safe, correct site surgery and by engaging patients in mitigating correct site surgical errors. Therefore, inclusion of patients as an integral part of the healthcare team is necessary through education and encouragement to speak out.

WHO High 5s Project: Medication Reconciliation International Meeting

ABSTRACTMedication reconciliation is in the forefront of medication safety programs, both in Australia due in part to updated accreditation standards, and globally. The first international meeting for hospitals participating in the WHO's High 5s Project was convened in Geneva in October 2012. The meeting was attended by delegates from hospitals in 6 countries participating in 2 of the WHO patient safety initiatives: medication reconciliation and correct site surgery. Networking with European colleagues provided an opportunity to exchange ideas and collaborate to address common medication safety issues.

Use of Checklist Prevents Errors during Surgeries

ABSTRACT ‘Hospitals do most of the right things, on most patients, most of the time. The checklist helps them to do all the right things, on all patients, all the time.’ According to International Patient Safety Goal-4 (IPSG-4), the hospitals need to ensure the correct patient, correct site, correct procedure and correct surgery. WHO launched Safe Surgery Saves Lives program in 2009 to reduce the number of surgical deaths across the globe. In the complex setting of an operating room, any of the steps may be overlooked during the fast-paced preoperative, intraoperative, or postoperative preparations. So a customized checklist was introduced after sensitization and training of all OT users to reinforce accepted safety practices and foster better communication and team work between clinical disciplines. The aim of the checklist is to reduce the number of errors during surgery and to reduce postoperative complications. The use of the checklist reduced the rate of deaths and complications by more than one-third. The rate of major inpatient complications dropped from 11 to 7%, and the inpatient death rate following major operations fell from 1.5 to 0.8% after implementation of the checklist. Audit tool printed at the backside of the checklist is analyzed every month, to observe the shortcomings. How to cite this article Kumar J, Sud A. Use of Checklist Prevents Errors during Surgeries. Int J Res Foundation Hosp Healthc Adm 2013;1(1):25-28.

Current Practice on Preoperative Correct Site Surgical Marking

Performing surgery at an incorrect site has devastating outcomes. The National Patient Safety agency and Royal College of Surgeons England have provided recommendations to promote correct site surgery with emphasis on surgical markings. There is little published data on surgical site marking practices amongst surgeons. A prospective audit on surgical site marking was performed on 500 surgical procedures: 204 inguinal hernias, 35 umbilical hernias, 48 varicose veins, 40 toenail removals, 123 excisions of skin lesions, 10 femoral artery procedures and 40 breast procedures. The results showed that 59% of markings were visible in theatre post sterile draping, 40.4% markings were not visible, and 0.6% (3/500) were not marked. Recommendations suggest the use of an arrow with an indelible marker pen. Our results show the use of an arrow in 64% of patients and this was the most common form of mark used. An appropriate marker pen was used on 88% of patients. There is no evident published data to compare our practice to that of other surgical units, however, to improve correct site surgery markings should be visible, recognisable and understood by all specialties and grades. A universal marking system to improve correct site surgery may be beneficial.

Correct site surgery — are we up to standard?

Abstract To examine the impact made on safe surgical practice by the introduction of correct site surgery documentation in a children’s hospital containing a surgical unit in South Yorkshire. A retrospective audit of randomly selected case notes of children attending the hospital for an ENT/Plastic surgery/Orthopaedic/General surgical procedure during a period in 2006 or 2008. Outcome measures included the total, correct and legible completion of correct site surgery documentation pre-operatively. Significant improvement was noted between the 2006 and 2008 audits in the amount of patients being correctly marked (33% vs. 91%), however there were no forms in either study that were fully and correctly completed. Legibility of the forms also improved markedly between the studies (33% vs. 98%). The completion of correct site surgery forms improved with greater publicisation of the forms, however the practicality of the numbers of people required to complete the forms needs to be reviewed. The international introduction of such forms will generate valuable data as to the future utility of these checklists.

Surgical safety checklist saves lives?

The WHO Safe Surgery Saves Lives Study Group has recently published a study of surgical outcomes before and after implementation of a surgical safety checklist in the New England Journal of Medicine.1 After implementation, deaths were reduced by 47% and in-hospital complications by 36%. The observed improvement was seen across eight different study hospitals based in high, middle and low income countries. As suggested by the authors, whereas the exact mechanism for the observed improvements in outcomes is unclear, it is almost certainly multifactorial. On the basis of these startling results, the National Patient Safety Agency in the United Kingdom has issued an alert mandating that an adapted version of the checklist should be completed for every patient undergoing a surgical procedure in England and Wales, with full implementation by February 2010.2 The goals are quite clear – to improve anaesthetic safety practices, to ensure correct site surgery, to avoid surgical site infections and to improve communication within the team. Although the checklist looks simple, logical and impressive, the sceptics are quietly watching its development. Some surgeons or surgical units that do not implement such a checklist would show people a clean balance sheet with no mishaps in their own results to prove that there is no need of such a checklist. Some would suggest that their current practice of ‘time-out’ or ‘briefing’ would be more than adequate in preventing surgical incidents. Worse still, some may simply regard the adoption of such a checklist as an admission that their practices are unsafe. Perhaps, by adopting a checklist, as is done in aviation and other industries, some would feel a drop in the professional pride of their work in hospitals. Whether surgeons around the globe would embrace this new wave of surgical safety checklists with open arms remains to be seen. Some surgical units would use the top-down approach and some would use the bottom-up approach. It does not really matter that much. The devil is there in the implementation. For example, mechanical compliance with a simple tick-box exercise would not bring about any significant changes. Underneath that single sheet of paper is the need to change our surgical culture – surgeons are expected to be safer than just safe. If we surgeons become patients ourselves, wouldn't it be nice to know everyone in the operating theatre (OT) – anaesthetists, surgeons and nurses – are spending a few minutes (while you have been put to sleep with a tube in your throat!) ensuring that all OT team players know the surgical plan and have the correct instruments handy?

Preoperative limb marking and verification checklist: a compliance issue?

Surgery at an incorrect site is rare but has disastrous consequences. In the UK, adverse events cost approximately £2 billion/year in additional hospital stays alone.1 The “Correct Site Surgery” alert...

Surgical Time Outs in a Combat Zone

AORN supports the Joint Commission's requirements and guidelines to promote correct site surgery, including preoperative verification, site marking, and conducting and documenting a surgical time out. This article highlights the success of a well-implemented surgical time out policy and procedure at a two-bed combat support hospital in northern Iraq. Policy implementation, training, documentation, and quality management chart checks prevented any incidence of wrong site surgery through the completion of more than 900 procedures on more than 400 patients during a 15-month period.

Preoperative site marking

It is with great interest that we noted the comments on correct site surgery and preoperative site marking.1 In our own experience, we have recently encountered two episodes of sub-Tenon’s...

Assessment of the implementation of a national patient safety alert to reduce wrong site surgery

Background:In 2005, guidance on how to prevent wrong site surgery in the form of a national safety alert was issued to all NHS hospital trusts in England and Wales by...

Safer patients in surgery

Earlier in 2008 the World Health Organisation (WHO) launched its second global campaign, Safe Surgery Saves Lives, to reduce the number of errors occurring in surgery on a worldwide basis. The focus of the campaign is a surgical safety checklist, which addresses issues such as haemorrhage risk, antibiotic prophylaxis, airway management, allergy and correct site surgery. The Royal College of Surgeons of England endorsed the principles of the WHO global campaign.

Time Out: An Analysis

Ensuring patient safety in the OR includes performing a time out to help prevent wrong site surgery. The circulating nurse, in the role of patient advocate, usually is the OR team member who initiates the time out. A correctly performed time out includes verifying the correct patient; procedure; site (eg, organ, limb, vertebral level, laterality); surgeon; and position, as well as that proper equipment, instrumentation, and implants are available. Unacceptable time outs can be categorized as borderline, contrary, related, illegitimate, or invented cases. Health care systems should follow the Joint Commission's Universal Protocol and should have tools in place to ensure that patients will undergo correct site surgery.

Update on correct site surgery

Update on correct site surgery

Promoting Correct Site Surgery: A National Approach

Surgical procedures undertaken at the wrong site represent a potentially devastating event for everyone involved. Wrong site surgery is defined as surgery performed at the incorrect anatomical site--either the wrong side (left leg instead of right) or the incorrect anatomical location or level (incorrect finger on the correct hand). The National Patient Safety Agency (NPSA) and the Royal College of Surgeons of England (RCS) last year issued a joint alert (NPSA 2005a) to promote correct site surgery. This aims to clarify the steps required and ensure that the intended and correct surgical procedure is performed on the correct patient at the correct site.

Correct Site Surgery

Dear AfPP I am an anaesthetic practitioner working within a busy surgical day unit. In recent months, while undertaking presurgical checks with the patient and ward nurse, I have reported a number of incidents where patients have not had their site of surgery marked. On one particular occasion the wrong site had been marked. There is confusion among medical staff as to how the intended surgical site should be marked. Please could you clarify whether there are any national standards for correct site surgery. Concerned from Cambridge

Collaborating to manage vendor interactions and protect quality of care in the OR

A culture that provides for safe patient environments demands that health care risk managers address all barriers to safe care, sometimes in extraordinary ways. For example, the operating room is one environment that has gained attention with policies on performing "time outs" before beginning a case and strong emphasis on correct site, correct patient and correct procedure surgery. However, a common hospital practice that has been generally accepted is to invite, allow and encourage sales representatives, or vendors, into the operating room to help surgeons use new equipment or devices. This article will describe how risk managers - partnering with their facility's sourcing and materials management departments - were able to influence a network-wide shift in vendor interactions in the operating room to create safer places for patient care.

Ensuring correct site surgery

AORN is committed to promoting the identification of the correct surgical site. Using the suggested risk-prevention strategies when developing policies and procedures will reduce the risk of error. AORN's position statement on correct site surgery is available on AORN Online (i.e., http://www.aorn.org/about/positions/correct site.htm). Other resources can be found on the Patient Safety First web site (i.e., http://www.patient safetyfirst.org). As patient advocates, perioperative RNs should communicate with all members of the surgical team to verify the correct surgical site. Individual facility policy should clearly delineate the role and responsibility of the physician and other team members in marking and verifying the patient's-identity and the correct surgical site, procedure, and laterality. Perioperative nurses also should think about the last time an error or a near miss related to wrong site surgery occurred. Compare your facility's current policy and procedure to JCAHO recommendations and work within your facility to develop, implement, and monitor a collaboratively developed, multidisciplinary policy and procedure. If your facility has not addressed the issue of wrong site surgery, learn more about why this problem occurs and see what you can do to make correct site surgery an expectation--100% of the time.

Examination: Ensuring Correct Site Surgery

AORN JournalVolume 76, Issue 5 p. 779-782 Patient Safety First Examination: Ensuring Correct Site Surgery First published: 01 November 2002 https://doi.org/10.1016/S0001-2092(06)61030-2 AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AORN recognizes these activities as continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Credential Center approves or endorses products mentioned in the activity. AORN is provider approved by the California Board of Registered Nursing, Provider Number CEP 13019. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume76, Issue5November 2002Pages 779-782 RelatedInformation

Banked tissue; correct site surgery; procedure rooms; disaster plans for terrorist activity

Banked tissue; correct site surgery; procedure rooms; disaster plans for terrorist activity