WELCOME

Joint Commission International Center for Patient Safety

MEETING THE CHALLENGES OF PATIENT SAFTEY: A NURSING PERSPECTIVE

Topic- Performance of Correct Procedure at Correct Body Site

Dr. Mary Mathews N. Professor and Principal MGM College of Nursing Kamothe

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DEFINITION OF PATIENT SAFTEY

The prevention of harm to patientsInstitute of Medicine 2008 ie.freedom from accidental or preventable injuries produced by medical care.
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PATIENT SAFTEY, NURSING RESPONSIBILITY

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INTERNATIONAL PATIENT SAFETY GOALS :

Goal Goal Goal Goal (1) identify patients correctly. (2) improve effective Communication. (3) improve the safety of high-alert medications. (4) ensure correct-site, correct-procedure, correct-patient surgery. Goal (5) reduce the risk of health careassociated infections. Goal (6) reduce the risk of patient harm resulting from falls.

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SURGICAL SCENE

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WRONG SITE SURGERY

Wrong-site surgery OR WSS encompasses

Wrong side or site Wrong procedure Wrong patient

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WRONG SITE SURGERY

Include surgeries done in

Operation Rooms Endoscopy units Interventional radiology unit Special procedure units

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WRONG SITE SURGERY

2 common examples
1. Wrong-site surgery

2.Retained instrument or sponge following

surgery.
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IMPACT-WSS

Patient
Surgical Team Surgeon

Insurance
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INCIDENCE

Orthopedics
General Surgery Urology

Neurosurgery
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THE PROBLEM
44% - left-right mix-ups on the correct patient 36% - wrong patient 14% - wrong implant or procedure on correct patient 7% - wrong site on correct patient

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WSS-CAUSES
Communication Procedure

Failure

- 70%

Noncompliance - 64% Issues - 46%

Leadership

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CAUSES
Organizational

No formal system
No check list

Exclusion of some members

Reliance only on surgeon Case overload Less pre-op time
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CAUSES

Unusual equipment / Positioning

Team competency
Information Organizational culture

Orientation & Training

Staffing Environmental safety

Continuum of Care
Patient Characteristics-obesity, unusual anatomy
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CAUSES
Process Factors

Poor patient assessment Poor team communication Many surgeons

Multiple procedures ,sites

No involvement of patient , family Noncompliance with procedures No verification before procedure

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PURPOSE OF PROTOCOL
Ensure:

Correct site
Correct patient

Correct procedure
Correct implant (if applicable)

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SAFE SURGERY SAVES LIVES

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S.I.T.E . BUNDLE
S = I = T = E = Sign site with initials Informed Consent & Verification Time-Out Effective Communication

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S - SIGN SITE WITH INITIALS

ACTION : Mark the procedure site.

Document site
Marks site with initials-permanent marker

Mark visible when patient positioned and draped

Verifies patient identity, correct site and side

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S - SIGN SITE WITH INITIALS

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S - SIGN SITE WITH INITIALS

Exceptions to marking:
Single organ Teeth Premature infant Site not predetermined Procedure through orifice & not associated with laterality Cardiac Catheterization

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S - SIGN SITE WITH INITIALS

Surgeon s physical presence from

arrival to conclusion of procedure

Site sensitive areas may be marked

above or lateral to the site

Patient refusal document

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I - INFORMED CONSENT & VERIFICATION

ACTION : Verify.

Informed consent Patient identification with two indicators. Procedure to be performed. Procedure site and laterality and/or level

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I - INFORMED CONSENT & VERIFICATION

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T - TIME-OUT
ACTION : Active, verbal participation in Time-out by Full Team
In OR, surgeon is responsible for calling for

time-out prior to starting the procedure.

All team members to stop other activities and pause

for the duration of the time-out.

Each member of the surgical/procedure team is

to give an independent, verbal confirmation.

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TIME OUT
Immediately prior to Surgery

A standard method is a time out, during which a designated member of OR team states: the name of the patient the procedure to be performed the site of the procedure, including laterality the implant to be used (if applicable)

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TIME OUT
Immediately prior to surgery
For procedures during which physicians will refer to pre-existing images, two members of OR team confirm that images are available, correct, properly labeled, and properly presented

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T - TIME-OUT
Resolve doubts in

discrepancies during time out.

An additional time-out is performed if there is a

disruption during the time-out.

A briefing (hand-off) for replacement staff if

staff changes occur during the procedure.

Anesthesia Time-out with one other member of

team before a block is administered.

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T - TIME-OUT
ACTION : Final visual check for site marking. The surgeon conducts a final visual check for the site mark immediately before the procedure after patient has been draped and positioned

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TIME OUT

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E - EFFECTIVE COMMUNICATION
ACTION : Team Communication
Pre-Operative Review Relevant images Implants or special equipment Special patient issues

Patient positioning and other pertinent

information
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E - EFFECTIVE COMMUNICATION
Intra-operative implants Implant specification/type/expiration date Size Laterality

Intra-operative internal laterality Verify target site Confirm procedure to be performed

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E - EFFECTIVE COMMUNICATION
Intra-operative Spine/other level procedures
Procedure site has been marked including anterior

or posterior, approximate level and laterality

Pre- and intra-operative imaging present Time-out verification process

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E - EFFECTIVE COMMUNICATION
Verification of level using fluroscopy

and compared with pre-operative

imaging
Intra-operative pause after midline

entry indicating laterality and level

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E EFFECTIVE COMMUNICATION

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REVIEW

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REVIEW

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REMEMBER

Think Patient Safety First !

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THANK YOU

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