A U G U S T 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 5 3
T
he patient had just been re-draped,
re-prepped and re-positioned, from
supine to lithotomy, and the surgeon was eager to restart
the case — a varicoclectomy followed by a bladder biop-
sy — without confirming everyone in the OR was on the
same page. Lt. Jessica Naranjo, BSN, RN, CNOR, knew better. Instinct
took over, and she voiced her concern: "Sir, I'd like to do a second
time out for patient safety."
After some initial resistance, the surgeon agreed and the OR team
took a second time out to verify the next phase of the procedure. The
case proceeded as planned, without incident.
"To be able to stand up to the surgeon and to quote policies and stan-
dards I had been taught took a lot of courage," says Ms. Naranjo, a peri-
operative staff nurse with Naval Hospital Jacksonville (Fla.). "If there's
one thing we learn as we're going through our training, it's that you have
SURGICAL
ERRORS
Reducing the Risks of
Wrong-Site Surgery
Key defenses in the battle to eliminate preventable harm include
the time out, pre-operative verification process and site marking.
Bill Donahue
Senior Editor
• LONG-TERM PAIN A wrong-site surgery or other
sentinel event can result in staggering costs and
cause lasting damage to a facility's reputation.
