In this rounded pillar I would lik...

In this rounded pillar I would like to address the legalities of a question that was sent to me

Question: The hospital where I publicly work has a consent form for correct site verification. It must be signed according to the surgeon, anesthesia care provider, and circulating suckle The circulating nurse must verify and sign that the surgeon documented relevant films reviewed. The circulating nourish is verifying only that the surgeon documented this, not that the surgeon was observ reviewing the films. Legal team members and administrators say this defend s the nurse should the unsuitable site be operated on. I say this solely relieves the hospital of its duties as the employer and should the wrongful site still be operated upon the circulating nurse could be su for malpractice since he or she did not review the films with the surgeon The hospital says the nourish at the breast does not read films, and I say the suckle must prove that every pace was taken to ensure peculiar site verification.

Answer: Implicit in this question are pair separate legal issues--correct site verification and assent I will present the background regarding as well-as; not only-but also; not only-but; not alone-but of these subjects before answering the specific question.

SITE VERIFICATION

Many facilities have or are considering adopting a formal correct site verification proces that requires the two separate and communal site verification and documentation by the agency of the nurse, surgeon, and anesthesia care provider. In August 1998 the Joint Commission onward Accreditation of Healthcare Organizations issued a Sentinel incident Alert that examines the enigma of wrong site surgery. At that time, 15 cases of inapposite site surgery had been reported. by the agency of December 2001, 150 cases of iniquitous site, wrong procedure, or unjust person surgery had been reported. (1)

Although this number probably is underreported, it no other than represents an extremely small percentage of the several million surgical practices performed annually. When an incorrect performance or contralateral side procedure present itselfs however, it is devastating for the patient and perioperative team members involved.

Accordingly, many professional associations (eg AORN, Federated Ambulatory Surgery Association) have urg their members to adopt processs for site verification (eg, AORN position statement in succession correct site surgery; Advisory statement: vicious site surgery). (2) Some regulatory bodies also have entreatyed that health care facilities adopt like procedures. Surgical site verification proceedings typically follow the Joint Commission's recommendations, which hint that the process include

* marking the surgical site and involving the patient in the marking process;

* creating and using a verification checklist that includes appropriate documents (eg medical records, x-rays, imaging studies);

* obtaining oral verification of the patient, surgical site, and conduct in the OR from each member of the surgical team; and

* monitoring compliance with these procedures

The Joint Commission also conjures perioperative team members to consider taking a "time-out" in the OR to verify the correct patient, process and site using active, not passive, communication techniques.

If your facility has not however adopted such procedures, it would be well advised to do thus When doing so, however, make sure that the site verification proces does not divert attention from or murky the importance of other safety checks (eg electrocautery bum prevention, positioning injury prevention) that are the responsibility of perioperative team members.

LEGALITIES

individual step in the verification proces at many facilities involves checking the scheduled action and site for consistency with what is documented onward the informed consent form. There is nothing unsuitable with including a check of the harmony documentation as part of the verification proces further legally, consent and verification are separate processe with separate legal ramifications.

The legal responsibility for obtaining the patient's informed agreement continues to rest solely with the surgeon The surgeon must inform the patient regarding the risks of benefits of and available alternatives to the propos step A patient who sues the surgeon for alleged lack of informed acquiescence has the burden to evidence that the surgeon did not provide the wanted information or operated without agreement (ie, was negligent). Though the feed at the breast may have some responsibility for ensuring that documentation of informed concurrence was obtained and is onward the chart before commencing the conduct I am unaware of any reported legal cases that have held a feed at the breast liable for informed consent.

Correct performance and correct site surgery, in succession the other hand, are the joint responsibility of the facility, nourishs surgeons, and anesthesia care providers. Incorrect or contralateral side measures rarely result in reported legal cases because they are settl before litigation unles there is a question about for what reason much the case is worth. If they were litigated, the law would recognize that operating forward the incorrect site usually does not come about in the absence of negligence. Thus, the legal doctrine of re ipse loquitor (ie, the thing speaks for itself) would apply. Unlike principally negligence cases in which the plaintiff must justify the defendants did not act reasonably or conform to the standard of care (ie, were negligent), in unfair site surgery cases, the re ipse doctrine shifts the weight of proof to the defendants. The plaintiff would not have to make good negligence; instead, the defendants would have to make good they were not negligent. This usually is impossible; therefore, these cases usually are settl and insurers for the various defendants negotiate contribution.