The idea of a wrong site surgery is almost unthinkable--going in for an operation at a well-respected hospital, and having the wrong arm, or wrong organ being operated upon. According to surgical unit experts, a major cause of wrong site surgeries is a lack of proper communication. This is because there are several doctors and nurses caring for one patient, with care being handed from one to another. Somewhere, like a horrific game of Telephone, the message becomes incorrect, resulting in a wrong site surgery. Confusion also occurs because documentation varies from hospital to hospital, with doctors working at different hospitals on different days. A new set of mandatory guidelines aims to eliminate such inconsistencies, and thus completely prevent wrong site surgeries.

The Joint Commission on Accreditation of Healthcare Organizations has made mandatory its guidelines for preventing wrong site surgery, effective July 1st. In July 2003, the Joint Commission (JCAHO) Board of Commissioners approved the universal protocol for preventing wrong site surgery, as well as wrong procedure and wrong person surgery. It was voluntary, and some locations still did not follow the guidelines. Now all medical sites, including doctor’s offices, will need to follow these procedures.
“It is pretty sad that wrong site surgeries occur in this day and age,” says Michael McCarry, an RN who is Vice President for Perioperative Services at the Hospital for Special Surgery in New York. “The statistics would say that wrong site surgery occurs in about one in every 15,000 cases. So it is a scary figure if you consider the number of surgeries that are carried in the country every year.”
The new guidelines pertain to operations and procedures done in settings other than the operating room, such as a radiology unit or an endoscopy unit. The guidelines involve multiple checks, starting with the preoperative evaluation, anytime the care is transferred to another doctor or nurse, and especially when marking the operative site. Wrong site surgeries often occur because of confusion between right and left, multiple structures such as fingers, or levels as in the spine. Clearly marking the operative site with a line or the word Yes, and having it initialed by the surgeon can go a long way in preventing wrong site surgeries.
One key to the new guidelines is a time out-- a process of making one last major check just before making any incision, or inserting a needle. “This means reviewing all the documentation, particularly the consent form identifying that it’s the correct patient and the correct surgical site and side that is to be operated on,” says McCarry.
The goal is to eliminate these completely preventable errors. “The acceptable rate of wrong site surgery is zero,” states McCarry.
To view the guidelines, click here:
http://www.jcaho.org/accredited+organizations/patient+safety/universal+protocol/index.htm

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