cal and anesthesia consents, and complete all pre-op screening require-
ments, nothing can replace a formal timeout with the entire team
before sedation or analgesia. Same goes for a regional block or a fire
timeout — they're adjuncts to the main timeout.
A second time out?
Not taking a second time out when a different surgeon performs a dif-
ferent procedure on the same patient is a leading cause of wrong-site
surgery, says the Joint Commission. But what about when multiple
procedures require position change and re-draping on the same
patient by the same team? For example, you move a patient from
supine into prone position, and the patient's left leg is now on his right
side. Or the shoulder is closed and the knee still needs to be fixed.
Should you conduct a separate time-out?
Yes, says Katherine L. Kirkham, MSN, RN, CNOR, of the University
of Florida Health-Shands in Gainesville, Fla. "To minimize confusion
and the potential for wrong-site surgery after you reposition a
patient," she says, "take a 'pause' or a mini time-out to confirm the
procedure, the surgical site and the marking."
Captain of the ship
The surgeon's participation is absolutely critical. "When time-outs and
other features of potentially effective surgical checklists fail —result-
ing in preventable, often harmful errors — studies indicate that the
7 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 1 8
What happens when nurses express a
concern during a time-out, but don't think
the surgeon is taking them seriously?
