Correct site identification and eli...

Correct site identification and elimination of unfit site, wrong procedure, and wicked patient surgeries are a national patient safety goal of the Joint Commission in succession Accreditation of Healthcare Organizations (JCAHO). The Joint Commission has commended creation of a preoperative verification proces involving the patient in marking the surgical site, and implementing a time-out pause to verify the consistency of all site, manner of proceeding and patient indicators one more time before a act begins. (1)

Certainly, extra effort to make secure patient safety is warranted given the severity of guilty site, wrong procedure, or inequitable patient surgery should it come to pass As early as 1947, referee Learned Hand prescribed that a reasonable one should take every precaution that is les onerous than the frequency of an injury multiplied through the severity of the injury should it come to one's mind (United States v Carroll Towing Co 159 F2d 169 [2d Cir 1947]) highly severe injuries thus require increased precautions unruffled though they occur infrequently; however, les sharp injuries require increased precaution as well. This article discusses those les strict injuries that may occur in the OR with more frequent occurrence Facts from cases reported during the last brace years were examined to identify injuries occurring in the OR that have comeed in litigation up to and including state appellate and predominant court decisions.

The LexisNexis database was searched for cases reported in the last brace years (ie, February 2002 to February 2004) that contain the words operating apartment and nurse and negligence or malpractice. Seventy-eight cases were listed. In three instances, couple cases dealt with the same situation, effectively yielding information about 75 cases. Of these, 44 disquieted alleged intraoperative injury. The other 32 involved injuries occurring elsewhere, preoperatively or postoperatively, with operating extent appearing as a part of the explanation of what happened if it were not that not as the location of the alleged malpractice (eg workers compensation cases, delayed or erroneous preoperative diagnosis, postoperative complication unrelated to intraoperative care, and occasional criminal cases). The 44 injuries that allegedly occurr in the OR were further analyzed for the oftenness and type of injury involved.

INDIVIDUAL ACTION OR INACTION

Twenty cases alleged errors in good sense or skill by the surgeon anesthesia care provider, or perfusionist. No direct perioperative encourage role in causing or failing to stop these injuries could be inferred from the case reports. Surgical injuries included

* air embolus and a transected artery during placement of a central venous catheter,

* failure to assess stenosis before initiating tracheostomy,

* a carve on a baby's finger after a cesarean section (C-section),

* a line of junction placed through a catheter during a bladder suspension procedure

* sting of a cribriform plate during septoplasty and functional endoscopic sinus surgery

* incomplete decompression and near exsanguination during back surgery

* cardiac arrest during valve replacement surgery and

* several instances of perforated bowel during laparoscopic and laparotomy procedures

Injuries allegedly caused through anesthesia care providers included

* perforated esophagus (ie, brace cases);

* late arrival, causing a delay in performing an necessity C-section;

* failure to delay an elective surgery despite a chart notation that the patient had pocketed a transient ischemic attack the evening before surgery;

* failure to assess and treat respiratory distress immediately after extubation;

* placement of an esophageal stethoscope in the patient's left lung; and

* unassessed cardiac arrest. united case involved the conceded negligence of a perfusionist who recorded normal life-current gas levels on his perfusion record despite laboratory reports of abnormal line gas levels that were not assessed or treated by way of the perfusionist.

Although none of these case reports put in mind ofed direct involvement of perioperative cherishs perioperative managers may wish to work with their surgery and anesthesia counterparts to re-examine communication and credentialing hypothesiss within a context of "could this pattern of injury happen here?" Several of these cases involved communication breakdowns or credentialing issues.

TEAM ACTION OR INACTION WITH foster INVOLVEMENT

Of direct interest to perioperative festers are the remaining 24 cases, which were categorized at type of injury and revealed a number of frequent issues, including

* assent (ie, four cases);

* retained foreign bodies (ie, four cases);

* squeezing injuries related to positioning (ie, four cases);

* unavailable equipment or implant sizes (ie, four cases);

* medication errors (ie, three cases);

* infection (ie, three cases); and

* scorchs (ie, two cases).

A possible blameworthy procedure occurred in only sum of two units cases, and these more likely were cases of inadequate explanation before consensus or inadequate consent documentation.