Reducing Wrong-Site Errors with a Surgical Safety Checklist

Surgeons confirm procedure and site with patient prior to surgeryThe Joint Commission Center for Transforming Healthcare is reporting that surgical errors are still a costly problem in healthcare facilities and the source of extreme anxiety for patients. People go into surgery expecting to get better and they find out that something went terribly wrong.

Wrong-site, wrong-procedure or wrong-patient surgery is preventable if procedures are followed and if candor is adopted as part of the culture of the hospital.

The World Health Organization (WHO) has produced a Surgical Safety Checklist that many facilities have adopted to prevent surgical errors. One of the main checklist items is referred to as a surgical team time out. This is where the anesthesiologist, the nurse, surgeon, doctor and patient are all together in the same room and state out loud the exact location where the procedure is to be performed. When they agree on the location and purpose of the surgery, the surgeon will them mark on the patient with a pen the area that will be operated on. When taking this step, the risk of error is reduced dramatically.

Despite these basic and seemingly effective patient safety checklists, there are cases where mistakes still occur. One surgical nurse shared a story where a consent form was submitted by the patient approving the location and purpose of the surgery however the surgical team did not have a "time out" with the patient prior to surgery. In this case, the nurse who spoke with the patient and collected the consent form confirmed the surgical site. The nurse marked the location on the patient. The patient was then put under anesthesia and the doctor began the surgery on the opposite side of the body. The nurse informed the doctor that the site he was preparing was incorrect but he insisted that he was right. When the nurse pushed the matter by citing the consent form, he stated that the consent form was wrong and proceeded with the surgery.

In this situation, the lack of trust between surgical team members caused the error. A true "time out" would have prevented it, although had the facility established a core value in patient safety, any doubt in the procedure being performed would have been enough to stop and verify the facts of the case.

Adopting a surgical safety checklist that includes a time out where the patient verbally acknowledges the site and procedure to be performed with the people that will be performing the surgery displays that patient safety is the top priority and it relieves the patient of unneeded anxiety about mishaps while they are under anesthesia.

by Linda Bright

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