The Institute of Medicine's report,...

The Institute of Medicine's report, To rove is Human: Building a Safer Health a whole brought national attention to the importance of improving patient safety. (1) each health care delivery system indigences a comprehensive approach to render certain correct site surgery. Procedures and protocols should be lay opened and implemented collaboratively by multidisciplinary teams, including the entire surgical team, readys in quality and risk management, and perioperative RNs

Perioperative RN have a function to the public to foster the patient from injury and to safeguard the patient's health, welfare, and safety. Although it is the surgeon's responsibility to determine the patient's ne for surgery and specify the surgical site, verification of the correct surgical site at the time of surgery is each clinician's responsibility. (2)

INCIDENCE OF immoral SITE SURGERY

The actual incidence of guilty site surgery is unknown, if it be not that the Physician Insurers Association of America (PIAA) did document the incidence of unsuitable site surgery from 1985 to 1995 After examining data from 22 medical malpractice carders representing 110000 physicians, PIAA reported 225 claims for orthopedic wrongful site surgery and 106 claims for other surgical specialties. (3) According to a December 2001 Sentinel result Alert reporting on 150 cases of sinful site surgery, wrong site surgery is principally prevalent in orthopedic, podiatric, general, neurologic, and urologic proceedings These events occur in all patterns of surgical settings. According to the alert, 58% of the 150 reported cases occurr in ambulatory settings, 29% occurr in inpatient ORs, and 13% occurr in other inpatient facilities. (4) chiefly recently, the Joint Commission forward Accreditation of Healthcare Organizations reports that as of June 26 2002 197 cases of improper site surgery have been reported. (5)

WHAT IS blameworthy SITE SURGERY?

The Joint Commission defines iniquitous site surgery as any surgery performed in succession the wrong site or patient or performance of the inappropriate procedure. (6) Most would argue that considering the millions of surgeries and other invasive acts performed annually, these numbers ruminate an extremely low percentage. No undivided however, could deny the potential devastation involved in removing the wicked limb or body part, performing surgery onward the wrong patient, or subjecting a patient to the unfair surgical procedure.

FACTORS CONTRIBUTING TO evil SITE SURGERY

Many dexterouss have speculated about the factors that contribute to iniquitous site surgery. The Joint Commission has examined cases submitted by means of their sentinel event reporting classification and identified the following factors or situations as contributing to vicious site, wrong patient, or unjust procedure surgery:

* difficulty surgery,

* morbid obesity,

* physical deformity,

* unusual equipment or setup in the OR,

* multiple surgeons

* multiple procedures

* not requiring that the site be marked,

* not requiring verification in the OR,

* not requiring a verification checklist,

* incomplete patient assessment,

* staffing problems

* distractions,

* lack of access to pertinent information, and

* organizational culture

The Joint Commission also reports that in the majority of unfair site surgery cases, communication breaks down between surgical team members and the patient and his or her family members. (7)

In describing the central law of improvement, single in kind health care improvement expert recounts health care clinicians that "every a whole is perfectly designed to achieve the inferences it achieves." (8) Complex rules such as health care, appear to be more disposed to errors than others. In many major industries, a primary focus forward safety has led to the evolution of processes designed to minimize the risk of errors and accidents and limit damage in the adventure that errors do occur. A major factor contributing to sinful site surgery and all stamps of medical errors is that health care arrangements are not designed with safety as the first priority. For example, site verification practices and correct site statements not rarely focus on reducing the risk for malpractice claims and limiting liability instead of ensuring patient safety.

to what extent TO ENSURE CORRECT SITE SURGERY

In health care environments, clinicians frequently focus on what is convenient or efficient rather than focusing upon patient safety. Most experts agree that errors meet the eye as the result of multiple small factors, and it is no other than when these factors combine that an adverse adventure such as wrong site surgery actually come abouts Simplifying and standardizing processes, back-up combination of parts to form a wholes organizational design, and team performance can contribute to arrangement reliability and, thus, result in fewer errors and adverse events

The Joint Commission's recommendations to bring risks related to wrong site, guilty patient, and wrong procedure surgery include

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

* developing verification checklists that include related medical records or diagnostic studies;