Page 8
1 Schedule and verify
Accurately identifying the surgical site should begin at the physician's office, and everyone who plays a part in moving the patient's case to the OR should be fully informed. This includes your facility's scheduler, who is essentially the point of entry for patient information that must be verified all along the way, says Leopoldo Rodriguez, MD, FAAP, medical director and chief of anesthesiology at the Surgery Center of Aventura in Florida.
"The scheduler is the first to verify, on the booking sheet," he says. "They'll record an upcoming knee arthroscopy. Which side? If it's not listed, that should raise a red flag. They should call the physician's office and ask. Schedulers should be on the lookout for any procedure that can be bilateral or performed in multiple areas."
2 Confirm the patient, procedure and site
"Just a few years ago, we'd rely on patients' ID wristbands for identification," says Mary Stewart, RN, BSN, chief clinical officer at the Springfield (Ill.) Clinic. But not anymore. "What if they're not entirely correct? Or what if 2 patients in pre-op share a common name?"
The series of staff members who handle a patient's care throughout the peri-operative process should each use all the information cumulatively available to them — schedule, consent form, H&P, communication with the patient — in order to confirm the patient, procedure and site, says John Clarke, MD, a professor of surgery at Philadelphia's Drexel University and clinical director for the Pennsylvania Patient Safety Authority.
A surgeon who asks the nurse, "What does the schedule say?" is erring on
more than one level, he notes. "That's one piece of information. You need to gather all the information you can to confirm that it agrees with what you understand to be true. Scribbling from memory is not a fail-safe process."
Individual verification is particularly critical when patients change hands. Dr. Rodriguez cites staff changes during breaks or shift ends as the most common cause of patient identification errors, and urges nurses taking over for others to conduct their own verification of the patient, procedure and site.
