2 4 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E O C T O B E R 2 0 1 5
ing from the surgeon's office to the scheduler, to pre-op and to the OR — it
should be checked against the "gold standard," typically the original docu-
ments from the surgeon's office. By being proactive, you can limit mistakes in
the OR caused by oversights that occur upstream.
3. Standardization is essential
You cannot have a policy that simply requires surgeons to mark the surgical site,
without some additional structure and details. Ambiguity is one of the main rea-
sons clinicians do not follow guidelines. This type of policy creates the possibili-
ty of marking variation — one surgeon might write "yes" on the surgical site,
another may write "no" on the opposite appendage — that leads to errors.
Instead, the optimal site marking for any surgery is the one that all of your cli-
nicians can agree on and commit to use. Having a single way for every single
physician to mark the site is best, but at the very least each type of surgery
should have a consistent marking policy.
Once a decision on how all sites will be marked is made, make it clear that all
physicians are expected to follow the policy. If a particular specialty feels it has
a better method for their procedures, allow those clinicians to present their
argument to leadership. If their fellow clinicians back them up, consider allow-
ing the deviation. The key here is that any allowed variation of site marking
occurs by surgery type, not by individual surgeons.
4. You must prove the site is right
Even though the time out has been adopted by most healthcare organizations,
wrong-site surgery is still happening. While, as discussed above, many errors
start upstream, the time out is still an essential part of your prevention efforts.
What researchers have found is that too often these checks that are
designed to prevent errors are being done mindlessly. Instead of attentively
going through checklists, staff and surgeon go through the motions and look
at it as just one more step in the process.
