Byrum, the CEO and co-founder of HRS Consulting. "Consistent,
replicable processes and procedures are the most reliable defensive
tools for the team that cares enough to do a quality time out. We owe
our patients nothing less."
Of our survey respondents, 11% acknowledge that the marks made
in their facilities vary, depending on the surgeon.
"Typically, it's the surgeon's initials, but occasionally it's a line," says
one administrator. "We use an 'X,' YES or the patient's initials," says
another. That kind of variety, experts say, is a recipe for trouble. "We
don't do 'X' because there could be confusion as to whether 'X' means
not this site or yes, this site," another facility leader correctly points
out.
Do arrows, dots or patient initials, which might be made by anyone,
downplay the essential nature of the surgeon's understanding and
acknowledgement? The mark you use, says the protocol, must be
"unambiguous" and "used consistently throughout the organization."
Who's responsible?
Studies show that among the most common factors contributing to
wrong-site surgery are lack of standardization, lack of clear policies
and failure to clearly identify responsibilities.
The protocol is clear: The responsibility for marking the surgical site
belongs to the "independent practitioner who is ultimately accountable
for the procedure and (who) will be present when the procedure is
performed." In "limited circumstances," it continues, responsibility
"may be delegated to some medical residents, physician assistants or
advanced practice registered nurses."
One gets the feeling that there's considerably more delegating going
on than the authors envisioned. In fact, more than 3% of our survey
respondents say either the pre-op nurse or the OR nurse is responsi-
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