Risk Reduction Strategies Aimed at Preventing Wrong Site Surgery

Introduction

In consideration of the experienced case where an arthroscopy procedure was performed on the wrong leg, it is essential to provide strategies that can help in evading the occurrence of similar situations. However, an understanding of the causes of the issue is vital in need to offer reduction strategies. Furthermore, it is more efficient to classify the recommended risk reduction strategies aimed at preventing wrong-site surgery by establishing the problem. The identified causes of wrong-site surgery can be classified into scheduling, pre-operative, operating room and organizational culture. Consequently, the most efficient risk reduction strategies include streamlining the scheduling process, averting inconsistencies in the preoperative stage, averting operating room defects and creating good organizational culture.

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Streamlining the Scheduling Process

The root cause of the identified case of wrong-site surgery originated from the scheduling process. The processes utilized in scheduling the surgery enhanced the risk of incurring a wrong-site surgical operation. Office schedulers are individuals who perform verification procedures for a patient's presence and facilitate the filling process on booking documents. Scheduling of surgeries may occur verbally in a direct conversation, orally by phone or electronically through avenues such as emails and websites. The described surgical problem arose due to a number of misappropriations in the scheduling stage. Office schedulers failed to verify the present patient or verify the exact place where surgery was to be performed. This problem can be solved by planning for early confirmation procedures before the day of surgery. Office scheduler should make it a priority to confirm the accuracy of primary documents, for instance, original surgical forms or procedural orders prior to the day of surgery (Russ, Arora &Wharton, 2013). Verification of the correctness and appropriateness of the information should be followed by validations and ultimately signing by the involved people. The administration should discontinue verbal bookings and embrace written reservations. Schedulers who attempt to perform oral scheduling should be redirected to submit written requests. The main reason for this is to allow for documentation and follow-up. Verbal requests for surgical booking lack verification. This makes it hard to follow up and confirm if the surgical site the surgeon wants to work on was the right one. Lastly, physicians should be educated to perform extra checks and verify forms before accepting them. They should be trained to reject forms written with unapproved or unrecognized abbreviations. The administration should make it a policy to allow consented forms that are clear, correct and legible. The types should not have cross-outs. Consents that fail to meet the recommended criteria should be returned to physician offices for correction. Rejecting booking forms with unapproved abbreviations, cross-outs and illegible handwriting can help in evading wrong-site surgery accidents that occur due to the incompetence of schedules.

Averting Inconsistencies in the Preoperative Stage

The preoperative assessment and handling stage entails preoperative defects such as inconsistencies in the use of the site-marking protocol. The markings made using the unapproved surgical site, ascertains verification requirements of the patient. First, the specific primary documents should be availed 48 hours before the surgical session. The scenario will give assessors sufficient time to check for inconsistencies in the medical records. With this approach, assessors will have an opportunity to interrupt the schedule in the operating room with an alert to the members of staff so that they can treat the case as high risk. This strategy will ensure that primary documents such as surgeon's booking orders, consent, operating room schedule and physical reports lack inconsistencies. Second, the administration should create a new protocol that necessitates surgeons to use specific surgical-site markers with consistent mark types (Braaf, Manias & Riley, 2011). The administration can put the surgeon's initials close to the incision site. This strategy aims to reduce the levels of inconsistencies during site marking. Some of the discrepancies that the move evades are other people making marks other than the surgeon's mark site with unapproved surgical markers or failure of a surgeon to create a site mark on a patient. The absence of site markings on the skin of a patient is a huge cause of confusion. The use of inconsistent site marks may also confuse surgeons leading them to a wrong site. Third, a standardized time-out process should be incorporated in verifying patients, sides, and locations for all possible regional blocks. Members of staff should be educated about the value of standardized procedures so that they can be held accountable for their responsibility for risk reduction. The organization should specify and delegate roles. This approach will avoid inconsistencies with time-out processes for several regional blocks. Fourth, the personnel should be educated about the importance of standardized procedures and ensure that they adhere to standardized verification protocols. The organization should also create an environment where members of staff are free to speak up whenever the health status of a patient is at risk. This strategy will eliminate issues of inadequate verification processes of patient information due to different distractions. Verification of details should be a team effort for accountability purposes.

Averting Operating Room Defects

The operating room is also a prime factor in the occurrence of wrong surgical-site experiences. The organization needs to embrace some recommendations that will evade operating room defects such as distractions that develop from timeouts. Defects manifest in cases where there is ineffective communication during the briefing process (Gibbs, 2012). In the case at hand, the surgeon embarked on the surgical procedure without giving his view in regards to the surgical site. The administration needs to consider allocating sufficient time for briefing sessions. Such factors occur because the meetings determine the success and the efficiency of the entire operation. There are some ways through which preoperative briefing sessions can be transformed into a victory. First, the preoperative briefing performance is done upon arrival in the operating room. The process should involve the patient to verify the identity of the patient, site, procedure and any other critical information. Primary documentation should be availed, and site marks verified during the briefing session. Every team member should be given a chance to participate in the briefing session.

Creating a Good Organizational Culture

The organizational culture plays a significant role in the need to alleviate surgical site accidents. Some of the failures in the administration include inactiveness in their capability to engage and underpowered staff members in their ability to speak. The administration should create a sound organizational culture that spearheads in the alleviation of the surgical accident. The situation arises by creating awareness among team members to work in a way that is consistent with patient safety (Vachhani & Klopfenstein, 2013). Members of staff should be empowered to not only speak up but also use systems that identify emanating inconsistencies on time. The administration should create a culture that focuses on patient safety and promotes continual service readiness by incorporating national patient safety tools. Physicians that have been trained with service readiness show commitment in using improving processes such as minimum checklists to guide them in their progress. The administration should also empower staff members by allowing them to share data and ask questions. A good organizational culture enables staff members to speak in cases of patient safety concerns.

References

Braaf, S., Manias, E., & Riley, R. (2011). The role of documents and documentation in communication failure across the perioperative pathway. a literature review. International Journal of Nursing Studies, 48(8):1024-1038.

Gibbs, V.C. (2012). Thinking in three's: changing surgical patient safety practices in the complex modern operating room. World Journal of Gastroenterology, 18(46):6712-6719.

Russ, S., Arora, S., &Wharton, R. (2013). Measuring safety and efficiency in the operating room: development and validation of a metric for evaluating task execution in the operating room. Journal of American College of Surgeons, 216(3):472-481.

Vachhani, J.A., & Klopfenstein, J.D. (2013). Incidence of neurosurgical wrong-site surgery before and after implementation of the universal protocol. Neurosurgery, 72(4):590-595.