Controls may make wrong-site surgery almost impossible
The American Academy of Orthopaedic Surgeons (AAOS) in Rosemont, IL, recommends implementing a thorough system of checks and controls to avoid wrong-site surgery. In addition to the steps suggested by the Joint Commission on Accreditation of Healthcare Organizations — signing the patient, orally verifying the procedure, and taking a "timeout" to confer with the surgical team — the AAOS offers this advice:
- The patient’s records should always be available to the operating room (OR) team. The surgeon should check all records, films, and other indicators of the proper surgery site.
- Before anesthesia is started, ask the patient to indicate the correct site.
- The surgeon should not proceed unless the signature is visible. Never assume that the signature is under the drapes.
- Encourage the rest of the surgical team to confirm the signature site. Any member of the surgical team should feel comfortable questioning why there is no signature visible at the site about to be cut.
- Spinal surgery done at the wrong level can be prevented with an intraoperative X-ray that marks the exact vertebral level (site) of surgery.
- Institutional protocols should include these recommendations and involve OR nurses and technicians, hospital room committees, anesthesiologists, residents, and other preoperative allied health personnel.
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