done only after relevant pre-op images, surgical notes and consent
forms have been reviewed — and in collaboration with an awake,
alert patient before sedation. If possible, it should also include family
members of the patient. Site-marking should be done with reference
to what's called the "source of truth," which is typically a consent
form that is marked with the correct site and completed only by the
surgeon performing the procedure. Indelible marker, which won't
wipe away when an alcohol-based prep is applied, should always be
used to mark sites.
Be aware of risk factors associated with site markings. Errors can
occur because some sites are intrinsically difficult to mark, such as
the spine. The skin site does not correspond to the spine level, so
marking the skin is insufficient. The physician needs to review the
patient's radiology imaging, but imaging while the patient is positioned
for surgery is not always clear. Having more than one person review-
ing the film can help, but during many procedures, there is often only
one team member who is experienced enough to interpret the imaging
to determine the correct spine level.
• Perform a time-out. Ultimately, you need to establish a safety
culture by improving communication within teams. This means not
just improving clarity of team communication, but also encouraging
all members of the team to speak up. Every member of your staff
should feel empowered to voice their concerns about patient safety
without fear of retribution, even if they're wrong. This is a crucial step
in preventing wrong-site surgery.
Your facility should have a zero-tolerance policy for intimidating
behavior and should create an environment where all team members
believe their thoughts and ideas matter. The leader in the OR —
whether it's the surgeon, attending surgeon or anesthesiologist —
needs to encourage all team members to feel included in the pre-op
time-out process. This can be done by allowing everyone to introduce
themselves, identify what their role will be during the procedure and
actively participate in the confirmation of the correct surgical site.
Due diligence
Making sure surgeons perform the correct procedure on the correct
patient at the correct site demands a coordinated and transparent
effort from every team member in your facility. The steps to prevent
wrong-site surgeries are more common sense than complex, but
implementing them on a daily basis can be challenging. Refocus your
efforts and recommit to ensuring the never events that keep happen-
ing in facilities across the country don't occur in your ORs.
OSM
O
C T O B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 1 3
viscotcs@viscot.com
800.221.0658
www.viscot.com
ChloraPrep™ is a trademark of Becton, Dickinson and Company.
XL Prep
Resistant Ink
...including ChloraPrep
™
Contact for trial offer
viscotcs@viscot.com
800.221.0658
www viscot com www.viscot.com
ChloraPrep™ is a trademark of Becton, Dickinson and Company.
Contact for trial offer
Visible after all preps
Dr. Pollak (epollak@jointcommission.org) is a practicing anesthesiolo-
gist, fellow of the American Society of Anesthesiologists, and the medical
director and patient safety officer for the Division of Healthcare
Improvement at the Joint Commission in Oakbrook Terrace, Ill.
