Question: In our facility, we have ...

Question: In our facility, we have no specific protocol for identifying the correct surgical site. We are In the proces of preparing for our Joint Commission forward Accreditation of Healthcare Organizations (JCAHO) take a view of and I have heard that the JCAHO is interested in seeing so a policy In facilities that perform surgery Should we have a policy, and, if likewise what should it include?

Answer: Although AORN has not addressed this question to date, it certainly be seens prudent for the facility to have a policy and operation in place and to behold that all people involved in patients' surgical care chase that policy and procedure. Any surgery that is performed onward the wrong site is a serious business The consequences for the patient and for the facility and its practitioners can be devastating. It is human nature to think that wrongsite surgery could in no degree occur, but in two years' time, the JCAHO's accreditation committee reviewed 15 cases of wrong-site surgery Others may have occurr further were not reported. The majority of reported wrong-site surgeries were orthopedic performances with urologic and neurosurgical measures also contributing to the total number of 15(1)

The JCAHO's reviewers identified several factors that may contribute to an increased risk of wrong-site surgery These include

* having more than the same surgeon involved in the procedure;

* performing multiple managements on the patient during a single surgical fight especially when different procedures are performed forward different sides of the patient;

* time compressings due to unusual start times;

* squeezing to decrease preoperative preparation time;

* patient characteristics requiring unusual equipment setup or patient positioning forward the surgical bed;

* failure to include the patient and/or family members when identifying the correct site;

* incomplete or inaccurate communication among members of the surgical team; and

* incomplete preoperative assessment of the patient(2)

Having identified possible contributing factors leading to wrong-site surgery the JCAHO insinuates the following strategies for reducing the risk of this serious error.

* Clearly mark the surgical site.

* Involve the patient in the proces of identifying the correct site to improve reliability.

* Require an oral verification of the correct site in the OR by dint of each member of the surgical team.

* unfold a verification checklist that includes all documents referencing the intended surgical act and site (eg, history and physical, surgical permit, x-rays or other image studies, surgery schedule).(3)

by dint of including such things in your policy, you will be creating a connected view of checks and balances that can contribute to safe practice.

Question: I am the director of a modern ambulatory surgery center (ASC), and my physician-owners want to be reimbursed far the Medicare patients we succor This was never mentioned until not long ago I was given carte blanche in bourns of obtaining accreditation, and the physicians have Indicated no election in this matter until now. greatest in quantity of my energy has been focused toward obtaining accreditation from one of the national accrediting agencies specifically for ambulatory surgery facilities, as it was as the American Association for the Accreditation of Ambulatory Surgery Facilities (AAAASF). It is my understanding that our facility will have to be certified from a state survey agency for us to receive Medicare reimbursement. Does this mean we will ne to prepare for pair surveys if we want the AAAASF accreditation?

Answer: As of Dec 2 1998 a facility of that kind as yours needs to prepare for barely one survey to obtain the couple Medicare and AAAASF certification. As of the December date, the Health Care Financing Administration (HCFA) approved "deemed" status for the AAAASF. This means that ambulatory surgery center meeting the certification requirements for AAASF are considered to have met the Medicare participation requirements. An additional state observe is no longer necessary. To participate in the Medicare program, ambulatory surgery center must suitable conditions for participation that are specified in HCFA regulations. In the past, ASCs inserted into a Medicare participation agreement, if it be not that only after being certified by way of a state certifying agency as complying with the conditions for participation plant forth by HCFA. These state agencies then demeanored interval surveys to determine that the facility continued to be in compliance with the conditions for participation. Any facility build not in compliance risked having its participation in the Medicare program terminated.(4)

Ambulatory surgery center achieving accreditation by means of a national accrediting body with believeed status are exempt from state agency overlooks Instead, the accredited facility is scaned according to the certification/ recertification protocol of the certifying material substance In addition to the AAAASF, the one and the other the JCAHO and the Accreditation Association for Ambulatory Health Care have been given opineed status by HCFA. All three of these accrediting bodies have a three-year resurvey revolution of time Keep in mind, however, that all AAAASF inspects are unannounced, and facilities are asked to submit staffing schedules to AAAASF forward a regular basis after completing an accreditation application. This is done in such a manner the AAAASF unannounced survey can be leadershiped when key staff members are available.