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1Joint Commission International Center for Patient Safety


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MEETING THE CHALLENGES OF

PATIENT SAFTEY:

A NURSING PERSPECTIVE

Topic- Performance of Correct

Procedure at Correct Body SiteDr. Mary Mathews N.

Professor and Principal

MGM College of NursingKamothe



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DEFINITION OF PATIENT

SAFTEY

The prevention of harm to patients-

Institute of Medicine 2008ie.freedom from accidental or

preventable injuries produced by

medical care.



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PATIENT SAFTEY, NURSING

RESPONSIBILITY



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SURGICAL SCENE



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WRONG SITE SURGERY

Wrong-site surgery OR WSS

encompasses

Wrong side or site

Wrong procedure

Wrong patient



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WRONG SITE SURGERY

Include surgeries done in

Operation Rooms

Endoscopy units

Interventional radiology unit

Special procedure units



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WRONG SITE SURGERY


2 common examples

1. Wrong-site surgery

2.Retained instrumentorsponge following

surgery.


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IMPACT-WSS


Patient

Surgical Team

Surgeon

Insurance


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INCIDENCE


Orthopedics

General Surgery

Urology

Neurosurgery


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THE PROBLEM

44% - left-right mix-ups on the

correct patient

36% - wrong patient14% - wrong implant or procedure

on correct patient

7% - wrong site on correct patient



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WSS-CAUSES


Communication Failure - 70%

Procedure Noncompliance - 64%

Leadership Issues - 46%


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CAUSES


Organizational

No formal system

No check list Exclusion of some members

Reliance only on surgeon

Case overload

Less pre-op time


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CAUSES


Unusual equipment / Positioning

Team competency

Information

Organizational culture

Orientation & Training

Staffing

Environmental safety Continuum of Care

Patient Characteristics-obesity, unusual anatomy


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CAUSES

Process Factors Poor patient assessment

Poor team communication

Many surgeons

Multiple procedures ,sites

No involvement of patient , family

Noncompliance with procedures

No verification before procedure



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PURPOSE OF PROTOCOL

Ensure:

Correct site

Correct patient

Correct procedure

Correct implant (if applicable)



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SAFE SURGERY SAVES LIVES



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S.I.T.E . BUNDLE


= Sign site with initials

= Informed Consent &Verification

= Time-Out

= Effective Communication


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S - SIGN SITE WITH INITIALS



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22

Exceptions to marking:

Single organ

Teeth

Premature infant

Site not predetermined

Procedure through orifice & not

associated with laterality Cardiac Catheterization


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Surgeon s physical presence from

arrival to conclusion of procedure

Site sensitive areas may be markedabove or lateral to the site

Patient refusal document


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I - INFORMED CONSENT &

VERIFICATION


ACTION : Verify.

Informed consent

Patient identification with two indicators.

Procedure to be performed.

Procedure site and laterality and/or level


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I - INFORMED CONSENT &

VERIFICATION


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T - TIME-OUT


ACTION : Active, verbal participation in Time-out

by Full Team

In OR, surgeon is responsible for calling for

time-out prior to starting the procedure.

All team members to stop other activities and pause

for the duration of the time-out.

Each member of the surgical/procedure team is

to give an independent, verbal confirmation.


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TIME OUT

Immediately prior to SurgeryA standard method is a time out, during which

a designated member of OR team states:

the name of the patient the procedure to be performed

the site of the procedure, including laterality

the implant to be used (if applicable)



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TIME OUT

Immediately prior to surgery

For procedures during which

physicians will refer to pre-existing

images, two members of OR teamconfirm that images are available,

correct, properly labeled, and properly

presented



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T - TIME-OUT


Resolve doubts in discrepancies during time out.

An additional time-out is performed if there is a

disruption during the time-out.

A briefing (hand-off) for replacement staff if

staff changes occur during the procedure.

Anesthesia Time-out with one other member of

team before a block is administered.


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T - TIME-OUT


ACTION : Final visual check for site

marking.

The surgeon conducts a final visual check

for the site mark immediately before the

procedure after patient has been draped

and positioned


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TIME OUT



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E - EFFECTIVE

COMMUNICATION


ACTION : TeamCommunication

Pre-Operative Review

Relevant images

Implants or special equipment

Special patient issues

Patient positioning and other pertinent

information


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E EFFECTIVE


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E - EFFECTIVE

COMMUNICATION


Verification of level using fluroscopy

and compared with pre-operative

imaging

Intra-operative pause after midline

entry indicating laterality and level


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EEFFECTIVE COMMUNICATION


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REVIEW



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REVIEW



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41J i t C i i I t ti l C t f P ti t S f t

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