Wrong Site Surgeries

Upon observation of the circulating nurse, I noticed that she was very interactive and involved in the surgery. One of the responsibilities of the circulating nurse is to retrieve any surgical supplies that are not available in the operating room and to make or receive any calls for the surgeon. During the surgery, I noticed the nurse call for an x-ray for the surgeon, the laboratory for biopsy samples, and the operating room floor front desk to inform them that the surgery would be later than expected. This is her responsibility as the surgeon cannot break sterility by touching the phone and it is easier for him to communicate through her and not leave the surgical site. Also in the operating room, I observed the scrub nurses’ roles. Before the operation, the scrub nurse opened all of the sterile packages, arranged them on the sterile field, and took count of what was there along with the circulating nurse. The scrub nurse did this because she is sterile during the entire procedure, and once the sterile packs are opened, the contents can only be handled by sterile personnel. The scrub nurse also was ready and waiting at the sterile field at all times to get the surgeon any equipment needed from the sterile field. This is helpful to the surgeon because it enables the surgeon to stay at the surgical site and convenient for when

A patient arrives at the hospital for their knee replacement surgery that has been scheduled for today. The patient is checked in at admitting and is called back to the pre-operative area by the nurse. The patient changes and the nursing staff begin to take the patient’s vital signs, review the patient’s history, draw blood for lab work and they let the patient know what to expect before, during and after surgery. The surgeon arrives and checks in with the patient, asks if they have any final questions before surgery and then leaves for the operating room to prepare. The patient is taken to the operating room, anesthesia is given, and the operation begins. The procedure goes smoothly and the patient is taken to the post-op area. When the patient comes out of the anesthesia, the surgeon

Also, by properly conducting a time-out session where the patient is provided with a standardized briefing prior to the patient is sedated in the OR could also eliminate some the sentinel or adverse events in the OR. Furthermore, follow a checklist, which not only pertains to the surgery itself, but also focuses on the other procedures involved such as admissions, anesthesia equipment, and discharge (Mulloy & Hughes 2008).

Before a procedure begins, the nurse anesthetist will discuss with a patient any medications the patient is taking as well as any allergies or illnesses the patient may have. This must be done so anesthesia can be safely administered. Nurse anesthetists then give a patient general anesthesia to put the patient to sleep so they feel no pain during surgery or they may administer a regional

Second, the nurse commences assessment with an evaluation of patient’s airway, breathing, and circulation for any signs of inadequate oxygenation and ventilation. One of the patients’ temperature was 102 F and the physician recommended pain medication (dilaudid) and it was administered instantly. The nurse gets vital signs and compare the result with intraoperative care. The nurse chart vital signs every 5 mins for the next 15mins, every 15mins for the next hour depending on the recovery state of the patient. I also noticed that for diabetic patients, the nurse checks for blood glucose and also compare result with intraoperative care unit result. Third, the nurse assess pain although the patients receive pain medication before surgery. Fourth, the nurse assess surgical site (dressings and drainage). Fifth, the nurse assess neurologic (level of consciousness, orientation, sensory & motor status, pupil size and reaction. Finally, the nurse assess gastrointestinal (nausea, vomiting, intake of

We will make sure that per our hospital policy we will I.D. the site at admission, whenever there is a patient transfer, and at preop we will communicate this with the patient whenever the patient is aware. We will strive to make sure that the surgical sites are appropriately marked per the site I.D. policy and that the patient is interactive in the process when applicable. As part of this policy we will also make sure that all necessary medical records and labs are readily available for the procedure. We will also make sure that all possibly needed equipment and supplies are present.

Surgical Technologists have an important role in the operation room (OR). There are different positions within the Surgical Technology field, including Scrub Surgical Technologist, Circulating Surgical Technologist, and Second Assisting Technologist. Scrub Surgical Technologists have a number of tasks, including prepping the patient for surgery, sterilizing the OR, gown and glove surgeons and assistants, and assists the surgeon and other surgical team members in a number of ways, such as passing instruments and dressing wounds. Circulating Surgical Technologists have a number of tasks as well, including checking patient’s charts, identifying patient and verifying the surgery that will be performed with consent forms, assisting anesthesia

The Joint Commission Standard UP.01.02.01 pertaining to site marking the operative site is also an area that we will focus on prior to our upcoming visit. According to the Joint Commission Guidelines this process should occur with the patient awake and aware. (www3.aaos.org) Therefore, Nightingale Community Hospital will require that all patients be marked prior to leaving the pre-procedure area. The site marking should be at or near the incision site and marking of any non operative sites or areas is not permitted. The mark should be obvious and unambiguously marked with a YES accompanied by the initials of the marker for identification purposes. (www3.aaos.org) The mark will be made using a permanent maker that will remain visible after the completion of the skin prep. All cases that involve laterality, multiple structures such as fingers or toes and levels (spine) will be marked. Site marking will not replace special intra-operative radiography or testing but will be performed in conjunction with these tests. (www3.aaos.org) Site marking will be made by either the surgeon or individuals in a residency program or licensed nurse practitioner or physician assistant

As noted by Haugen, Murugesh, Haaverstad, Eide, and Softeland (2013) wrong site surgery continues to be a problem that can be prevented through the use of a checklist. In 2008, WHO published guidelines to ensure the safety of surgical patients. The guidelines included

With all of the possible problems that could occur during surgery, a wrong-site, wrong-patient mistake is one that should never arise. Nightingale Community Hospital (NCH) fully understands the importance of doing away with these errors and has set up protocol to work towards this goal. While the protocol is in place, it is not fully compliant with Joint Commission (JC) standards.

VASNHS Surgical Specialty Outpatient department has a designated pre-operative management unit that oversees the patients undergoing surgery. The predicaments stem from various guidelines or protocol originating from numerous surgeons and clinics. At present, the pre-operative nurses abide simple pre-op instructions (NPO protocol, medications, what to bring, during the surgery, transportation, cancellation instructions) for the entire Surgical Specialty Outpatient department. Surgical procedures are being canceled due to lack of communications and cancelations of patients prior to surgery date.

Several barriers may prevent the change. The hospital may be under budget and not able to buy equipment needed to perform the procedure properly. Some surgeons set in their ways may not be easily persuaded into

Use at least two patient identifiers when providing care. Double checking of ID bands and ID/Driver’s license of patient if possible. Using labels to mark all materials /items needed for the procedures. A two person check off procedure must be implemented. Items requiring labeling include: patient records, signed consents, and all assessments, diagnostic tests and x-rays. Also included should be any item that is needed for the procedure (blood products, devices, and equipment). Using a matching system, so that all items in the procedure area are matched to the patient. The matching system must be completed by a minimum of two staff members. These staff members should include a qualified staff member, nursing staff involved in the procedure, recovery room staff, and discharge staff.

Not all surgical procedures are the same, each procedure necessitates very specific skills, expertise, knowledge, and

In spite all the literature, documentation, and the lack of decrease in wrong site surgery, there are still providers who continue to rush and have the philosophy that time is money. Safety events and adverse events cost a lot of money (Laureate Education, 2010). Although adherence to universal protocol is required by Joint Commission since July 1, 2004, wrong site, wrong procedure, and wrong patient errors still occur. The incidence of wrong site surgery can be improved but needs to have the full participation of everyone involved in the process. Some of the reasons believed to add to the risk of wrong site surgery include poor planning, lack of