Wrong Site Surgery Preoperative Checklist:
A Podiatric Public Service Announcement |
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Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
Mountain View
Medical &
Surgical Associates,
Madras, Oregon |
ll of us in surgical specialties have heard of, and hopefully not been involved with, cases of wrong site surgery. According to the American Academy of Orthopedic Surgeons:
| “From January 1995 through September 2003, 278 incidents of wrong site surgery were reported to JCAHO. Thirty five per cent of these involve orthopedic surgery. And JCAHO continues to receive five to eight new reports of wrong-site surgery every month. As of the end of January 2004, wrong-site surgery was the third highest sentinel event, accounting for more than 12 percent of all sentinel events reviewed by the Joint Commission since 1995.” Read more... |
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As a result of these worrying statistics, we’ve all been trained on preoperative surgical site marking and time outs. Our own professional societies are involved in the process. According to This Week @ ACFAS - 06/10/09:
| "ACFAS is a member of the JCAHO Professional and Technical Advisory Committee on Ambulatory Health Care. In this capacity, we recently participated in a conversation with JCAHO about the draft Universal Protocol (UP) designed to prevent wrong site/person procedure errors. The JCAHO has actively sought stakeholder input to assure that the UP is “effective and achievable” and plans to make further modifications based on these comments before the final UP is released. ACFAS will disseminate the UP when it becomes final." |
Of course we should. First, our residency training is on par with our MD and DO counterparts. If this is true, why shouldn’t we do our own H&P’s? I was recently told by one of our CRNAs that my preoperative H&Ps are better than some of the local family physicians. I recently received word from my local family practice group that if I send a patient for a preoperative H&P, I need to indicate what labs/tests I want ordered. How ridiculous is that? The preop evaluation dictates what tests should be ordered. If they are doing the evaluation, shouldn’t they determine what tests are to be performed? Why should I send the patient back to the primary care provider if I’m already doing the evaluation?
However, the problem continues nationally and internationally. To decrease the incidence of wrong patient, wrong procedure, wrong site surgery the World Health Organization has researched and instituted a surgical safety checklist . Based on a study by the Safe Surgery Saves Lives Study Group published in the New England Journal of Medicine, this 19 item checklist significantly reduces the incidence of postoperative morbidity and mortality. Follow this link for the full study.
In short, this checklist contains 3 primary components:
1) a preoperative checklist along the lines of a preflight airline checklist
2) a beefed up preincision time out
3) a postoperative sign out |
At my local hospital, we began implementing a modified version with little interruption to the preoperative steps of our surgeries. Our first steps included trialing the WHO’s checklist, meeting to discuss how we could modify it to suit our hospital situation, trialing the modified version, and then sending it through our surgery and general staff committees. Thus far, it has been well received. I would strongly recommend utilizing this checklist at your local hospitals and surgery centers with two suggestions. First, modify the checklist to suit your surgery and anesthesia departments and procedures. Second, this checklist requires buy-in from all staff members. Check out the full implementation manual or go to www.who.int/patientsafety/safesurgery/en for further information. Take this time out to improve the safety of your OR and hospital.
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Keep writing in with your thoughts and comments or visit eTalk on PRESENT Podiatry and start or get in on the discussion. We'll see you next week. Best wishes!
Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]
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