News | June 03, 2007

AORN Develops Correct Site Surgery Kit

June 4, 2007 — The Association of Perioperative Registered Nurses (AORN) has developed a Correct Site Surgery Tool Kit to assist healthcare providers in implementing the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Universal Protocol as part of National Time Out Day.

Wrong-site surgery and other preventable mistakes still occur frequently in U.S. operating rooms. That's why the American College of Surgeons (ACS) and The Joint Commission are both partnering with AORN on its annual National Time Out Day observance on June 20.

Established in 2004 as part of the Joint Commission's Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person SurgeryTM, a “time out” should be an integral step in all surgeries. However, a recent AORN survey on Universal Protocol finds that a time out is not taking place before every surgical procedure, which means patients are at risk.

The Correct Site surgery Tool Kit contains a variety of resources to educate healthcare providers about the JCAHO Universal Protocol and to assist them with its implementation and is endorsed by the American College of Surgeons, American Society of Anesthesiologists, American Society for Healthcare Risk Management, American Hospital Association and the American Association of Ambulatory Surgery Centers.The tool kit contains an educational CD-ROM, pocket reference card outlining the steps necessary to promote patient identification, site marking, and the “time out” and a template for a policy to assist in the development of facility policy to implement the Universal Protocol.

Also included are a listing of frequently asked questions, letters to Letters to nurses, physicians, facility chief executive officers, and healthcare risk managers encouraging standard implementation of the Universal Protocol across all facilities, information for patients and additional resources regarding correct site surgery.

“AORN’s Correct Site Surgery Toolkit is an excellent aid to transforming the principles embodied in the Universal Protocol into the day-to-day, hands-on practice of providing safe care to surgical patients,” said Richard Croteau, JCAHO Executive Director for Strategic Initiatives. “The emphasis on team functioning and the practical ‘how-to’ tips for implementing the requirements are invaluable and should be part of the orientation and training of every perioperative nurse.”

Performing surgery on the wrong site can have serious consequences for the patient as they may be affected emotionally as well as physically from surgery performed on the wrong surgical site. An ineffective surgical site verification procedure can contribute to the incidence of wrong site surgery.

Procedure shortcomings might include:
- Inadequate patient assessment
- Inadequate medical record review
- Lack of institutional policies and controls
- Miscommunication among members of the surgical team and the patient
- Exclusion of certain surgical team members
- Reliance solely on the surgeon for determining the correct surgical site

Other factors that may contribute to an increased risk of wrong site surgery include:
- Having more than one surgeon involved in the procedure
- Performing multiple procedures on multiple parts of a patient during a single surgical encounter
- Unusual time pressures and/or emergencies
- Pressure to reduce preoperative preparation time
- Special patient characteristics, including morbid obesity or physical challenges
- Unusual equipment or setup in the operating room
- Failure to include the patient and/or family members/significant others when identifying the correct site
- Use of abbreviations related to the surgical procedure, site, or laterality
- Problems related to illegible handwriting
- Incomplete or inaccurate communication among members of the surgical team

AORN is in agreement with and suggests the following strategies for developing facility procedures/protocols for identifying the correct surgical site
-Involve the patient and/or family members/significant others in identifying the correct site.
-Use a specified, clear, unambiguous, indelible, hypoallergenic, latex-free method for marking only the correct surgical site.
-Specify in individual facility policy and procedure how, when, and by whom the surgical site is to be marked.

Use a verification checklist immediately before surgery that includes the following:
- Verbal communication with the patient and/or family members/ significant others
- Medical record review, including the face sheet, history and physical, and preoperative assessment
- Review of the informed consent
- Review of all available imaging studies
- Direct observation of the marked surgical site
- Verbal verification of the correct site with each member of the surgical team
- A "timeout" by the surgical team immediately before the incision or start of the procedure for final confirmation of the surgical site
- Quality control initiatives to monitor compliance with protocol.
-Establish a process to address and clearly resolve any discrepancies noted during the verification process prior to beginning the procedure.

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