CENTRAL OKLAHOMA AORN

OFFICERS AND COMMITTEE CHAIRS

2000-2001    Click HERE

Found in February 2002 Issue

Question: I am a perioperative nurse educator responsible for two facilities in one health care system. One of these facilities is an ambulatory surgery center. I would like to develop and implement a policy for identifying the correct surgical site in both facilities. We have never had an incident, and nursing staff members in the facility where I work think it could never happen here. They are not interested in developing a protocol or procedure for identifying the correct surgical site. We identify patients by asking them to state their name, and the surgical site is checked by looking at the OR schedule and the surgical consent. Our circulating nurses think this is sufficient. Last year, I heard a lot about wrong site surgery, but I have not heard anything lately. Does AORN support having a policy and procedure for correct site surgery or is this no longer a problem?

Answer: AORN does support every facility having a policy and procedure for identifying the correct surgical site. Incorrect surgeries continue to be a serious problem. According to the Joint Commission on Accreditation of Healthcare Organizations, (JACHO), the number of reported cases of wrong ite surgery (ie, the wrong surgery being performed or surgery being performed on the wrong patient or the wrong site), has increased from 15 in 1996 to 150 in 2001. Joint Commission statistics show the following breakdown.

orthopedics/podiatrics, 41%

general surgery, 20%

neurosurgery, 14%

urology, 11% and

other, 14% in a variety of specialties.

Fifty-eight percent of incidents occurred in ambulatory surgery centers, 29% in inpatient OR’s, and 13% in emergency departments and/or intensive care units. Seventy-six percent of incidents involved surgery on the wrong body part or site.

The Joint Commission has identified a number of risk factors contributing to wrong site surgery (ie, incorrect surgeries, incorrect patients, incorrect sites). These include:

communication breakdown between members of the surgical team or family members.

absence of a policy and procedure for correct site identification,

incomplete patient assessments,

insufficient staffing, and

distraction factors.

AORN recommends that every facility performing surgical, interventional, or other invasive procedures have a policy and procedure in place for identifying the correct surgical site. The AORN position statement on correct site surgery suggests that facilities incorporate the following risk reduction strategies into their procedure or protocol:

specify in the policy and procedure how, when, and by whom the surgical site is to be identified.

use a specified, unambiguous, indelible method for marking the correct surgical site,

involve the patient, family members, or significant others in identifying the correct surgical site,

use a verification checklist immediately before surgery; and

use quality control initiatives to monitor compliance with policy or procedure.

The checklist should include the following:

verbal communication with the patient, family members, or significant others;

medical record review, including face sheet, history and physical, and preoperative assessment;

review of informed consent

review of all available imaging studies;

direct observation of the marked surgical site; and

verbal verification of the correct site with each member of the surgical team.

The importance of communication among perioperative team members cannot be overemphasized..No member of the team should be excluded or overlooked.

Each team member represents an additional check and ballance when identifying the correct surgical site.