What has changed in the universal protocol?
In every element of the revised 2009 "Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery," including verification of procedure, marking of site, and taking time out, The Joint Commission (TJC) has "gotten a bit more specific about who does what and when," says Peter Angood, MD, vice president and chief patient safety officer for TJC.
With verification, the revised protocol reinforces that every times the patient makes contact with the provider, the provider should verify that it's the right patient, procedure, and site, he says. (See when verification should occur, below.)
| When should you have verification?
The Joint Commission's revised 2009 "Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery" says the verification of the correct procedure, site, and person should happen:
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In marketing the site, TJC is more specific about the characteristics of the mark. The marking must takes into consideration laterality, the surface (flexor, extensor), the level (spine), or specific digit or lesion to be treated.
The revised universal protocol should help facilities that conduct a significant number of laparoscopic procedures if physicians have balked at marking the site, says Kate Moses, RN, CNOR, CPHQ, quality management nurse at Medical Arts Surgery Centers (MASC) in Miami. "The rationale that physicians used is that, 'I'm going in through the belly button, I can see which side needs surgery. I don't need to mark it,'but [the revised protocol says] it still needs to be marked," she says.
TJC also is trying to standardize how the mark is done and clarifying who should mark the site. Angood says, "The way we have phrased it is that a licensed independent practitioner or an individual who has been approved by the organization to perform the actual procedure — not the marking, but the procedure that's going to occur — one of those individuals will mark the site."
This revision is an important distinction, he says. "That individual, importantly, is involved directly with the procedure and will be present when the actual procedure is performed, so we're trying to get more focused on an experienced and approved individual involved with the procedure is marking the site," he says.
According to the universal protocol, the mark preferably should include the surgeon's or proceduralist's initials.
For the timeout section of the universal protocol, one addition is confirmation that an antibiotic prophylaxis was administered, if ordered.
In every element of the revised 2009 "Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery," including verification of procedure, marking of site, and taking time out, The Joint Commission (TJC) has "gotten a bit more specific about who does what and when," says Peter Angood, MD, vice president and chief patient safety officer for TJC.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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