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Wrong-site, wrong-procedure, wrong-patient surgery is an alarmingly common occurrence in health care organizations. These errors are the result of ineffective or inadequate communication between members of the surgical team, lack of patient involvement in site marking, and lack of procedures for verifying the operative site. In addition, inadequate patient assessment, inadequate medical record review, a culture that does not support open communication among surgical team members, problems related to illegible handwriting, and the use of abbreviations are frequent contributing factors.Organizations need to collaboratively develop a policy and/or procedure that is effective in eliminating this alarming problem. The policy includes a definition of surgery that incorporates at least those procedures that investigate and/or treat diseases and disorders of the human body through cutting, removing, altering, or insertion of diagnostic/ therapeutic scopes. The policy applies to any location in the organization where these procedures are performed. Evidence-based practices are described in The (US) Joint Commission’s Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery™.
The essential processes found in the Universal Protocol are
marking the surgical site;
a preoperative verification process; and
a time-out that is held immediately before the start of a procedure.
TIME OUT:
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