In 2000 the Institute of Medicine's...

In 2000 the Institute of Medicine's report, To trip is Human: Building a Safer Health rule brought national attention to the ne to improve patient safety. (1) AORN supports comprehensive approaches in each health care delivery connected view to ensure correct site surgery Policies, courses and protocols should be evolveed collaboratively by multidisciplinary teams that include perioperative RN surgeon anesthesia care providers, risk managers, and other health care professionals.

Perioperative RN should be first note of the scale participants in multidisciplinary teams as they perform the operations indicated in these procedures and protocols. As patient advocates, perioperative RN have a service to the public to screen the patient from injury and to safeguard the patient's health, welfare, and safety. (2) A central goal of perioperative nursing is to help the patient achieve a horizontal of wellness equal to or greater than that which he or she had before surgical intervention. Although it is the surgeon's responsibility to determine the patient's ne for surgery verifying the correct surgical site at the time of surgery is the responsibility of each health care provider.

BACKGROUND

unfair site surgery is a broad boundary that encompasses all surgical operations performed on the wrong patient, blameworthy body part, wrong side of the dead body or wrong level of the correctly identified anatomic site. (3) The Joint Commission onward Accreditation of Healthcare Organizations (JCAHO) considers all iniquitous site surgeries, regardless of the bulk of the procedure, to be sentinel marked occurrences As such, they are enthrall to review under the JCAHO sentinel result procedure. (4) This procedure calls for a etymon cause analysis of each sentinel result Review of several root cause analyses through the JCAHO accreditation committee of the board of commissioners establish that wrong site surgery mostly frequently occurs during orthopedic, urologic, and neurosurgical proceedings (5)

One of the first disposes to address wrong site surgery was the American Academy of Orthopaedic Surgeon (AAOS). Recognizing that evil site surgery is most everyday in orthopedic procedures, the AAOS is committed to eliminating the incidence of wicked site surgery and has exhibited a wrong site surgery advisory statement in which it notes that it is the surgeon's responsibility to identify and mark the correct surgical site. (6) Recognizing that evil site surgery is not merely an orthopedic problem, the AAOS called for a comprehensive effort by dint of other surgical specialties and health care professionals to exhibit protocols to effectively eliminate improper site surgery.

Other organizations and disposes including AORN, have chosen to address correct site surgery (Table 1) These disposes outline a number of specific measures and processe to make sure correct site surgery. The greatest in quantity recent recommendations were issued by way of JCAHO and address four elucidation processes as risk reduction strategies. These include

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

* creating and using a verification checklist, including pertinent medical records, x-rays, and/or imaging studies;

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

* monitoring compliance with these operations Additionally, JCAHO recommends that surgical teams consider taking a "time-out" in the OR to verify the correct patient, management and site using active communication techniques. (7) These same recommendations are an integral part of JCAHO's lately announced 2003 national patient safety goals and recommendations.

Performing surgery in succession the wrong site can have serious inferences for the patient. The patient may be affected emotionally, as well as physically, at surgery performed on the vicious surgical site. An ineffective surgical site verification practice can contribute to the incidence of evil site surgery. Other factors that can contribute to the incidence of wicked site surgery include:

* inadequate patient assessment;

* inadequate medical record review;

* lack of institutional policies and controls;

* miscommunication among members of the surgical team and the patient;

* exclusion of certain surgical team members;

* relying solely upon the surgeon to determine the correct surgical site; (8)

* having more than single surgeon involved in the procedure;

* performing multiple conducts on multiple parts of a patient during a single surgical encounter;

* unusual time presss or emergencies;

* urgency to reduce preoperative preparation time;

* special patient characteristics, including morbid obesity or other physical challenges;

* unusual equipment or setup in the OR;

* failure to include the patient and his or her family members and significant others when identifying the correct site;

* use of abbreviations related to the surgical management site, or laterality;

* vexed questions related to illegible handwriting; and

* incomplete or inaccurate communication among members of the surgical team. (9)