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| No. 20 | 
Nov 07, 2009, 05:20 AM
 Re: RI hospital fined $150,000 in 5th wrong-site surgery since 2007 Originally Posted by lucyapple  What about the camera's...what about (HIPAA) patient confidentiality??
You can rest assured that patients will have to sign a waiver before they have surgery at that facility.
Physicians can also make the claim, that videotaping a surgery for the purposes of only reviewing it in case of an error and it would only be viewed by those who would have the need to view it....one could easily argue that isn't a HIPAA violation.
 | | Advertisement Sponsored Links | | | | No. 21 |
Nov 07, 2009, 09:30 PM
Re: RI hospital fined $150,000 in 5th wrong-site surgery since 2007 Originally Posted by diane227 The time out needs to be done with the surgeon, nurses, patient and anesthesia. But you find that very often the physicians do not want to participate in this process. I absolutely cannot believe that a neurosurgeon operated on the incorrect side of the head!!! I have had surgery residents place chest tubes into the wrong side of the chest in an emergency but that is about it.
I feel that every patient who comes in for any elective surgery should be educated to scrub their operative site for three days with hibicleans and mark their surgical site themselves before they go to the hospital.
This is a shame, it really is. And ultimately the physician is responsible because he or she should know what part they are supposed to be operating on and what surgery they are supposed to be doing. Do we need to start holding their hands?
As a circulator, I feel this way..the staff in the room can do everything correctly, the identification, the final time out etc. But ultimately, it is the person making that incision(the surgeon) that has to be fully engaged in the process. If the surgical field is small, as in a mouth, eyes, ENT surgeries, people outside the sterile field such as the circulator and to an extent anesthesia, are going to have a hard time seeing where the incision is ultimately made.
I know that people look at incidents like this, and wonder if the staff are a bunch of morons. But, I'm not standing here being self-righteous, because this can happen to anyone. This is why I take the time-out stuff so seriously, because I've known doctors and nurses involved in these things. And they weren't morons or careless. IMO, you cannot think that this could never possibly happen at your hospital, because it can and does. Incidences of wrong site surgery are going up all over the country. Knock wood, this has never happened to me, and it won't. But, I am backed up by my boss and I'm enough of a ***** to put my foot down when there are issues. I've refused to plug the bovie and suction in until the time out is done. You have to have some serious nads in this job sometimes.
Also, I don't feel that it is smart to have patients pre-marking themselves for several reasons. When I interview pts pre-op, you'd be surprised at the number of people who are relatively clueless about what they are having done. Also, there is a very small contigent of people that are looking for a law suit or enjoy making things difficult. I interviewed a guy once that when asked what side we were going to be operating on, he smirked and said "left, no, I mean right. Oh well, you have a 50% chance of getting the right one".He did the same thing with his meds and allergies when asked. He was such a tool pre-op that the surgeon actually canceled his surgery! 
So, IMHO, i believe that the surgeon should mark in holding with the patient fully engaged with the process(if able).
| | No. 22 |
Nov 08, 2009, 03:28 AM
Re: RI hospital fined $150,000 in 5th wrong-site surgery since 2007 Originally Posted by SquirrelRN71 So, IMHO, i believe that the surgeon should mark in holding with the patient fully engaged with the process(if able).
This is what they do at my facility. The surgeon visits the patient prior to the surgery and final notes are made and marks are done.
I can understand when it comes to internal procedures, you cannot tell from the outside, always what is wrong on the inside....however...I don't understand when a surgeon actually gets "in" how he cannot look at whatever he/she is supposed to fix...and clearly tell that there is nothing wrong with it.
I just don't understand how a surgeon, of all physicians, cannot tell the difference internally.
| | No. 23 |
Nov 08, 2009, 10:45 AM
Re: RI hospital fined $150,000 in 5th wrong-site surgery since 2007
thats fine for the elective stuff but what about inpts that come in late evening. Most of the time the docs wouldn't see them until in holding and they are doped up on pain med. then they can't participate in the marking. doctors are certainly getting away with lots of stuff but they don't go thru some of the punishments the nurses do for the simplist stuff
| | No. 24 |
Nov 08, 2009, 11:48 AM
Re: RI hospital fined $150,000 in 5th wrong-site surgery since 2007 Originally Posted by HealingBalm Imagine what this poor patient (patients since this the 5th surgery gone awry) is going through! What about the patients!!!! 
A nurse could miss one signature in the medex and lose his/her license, if WE don't cross every I and dot every T.
State Boards can be merciless towards nurses!
I am outraged! 
How about cross every T & dot every i !!!
| | No. 25 |
Nov 08, 2009, 03:05 PM
Re: RI hospital fined $150,000 in 5th wrong-site surgery since 2007 Originally Posted by litbitblack thats fine for the elective stuff but what about inpts that come in late evening. Most of the time the docs wouldn't see them until in holding and they are doped up on pain med. then they can't participate in the marking. doctors are certainly getting away with lots of stuff but they don't go thru some of the punishments the nurses do for the simplist stuff
Our docs end up seeing them in the ER..that's where most of the off shift cases originate. And yes, there are cases where the pt. is unable to be much help in participating, either because of their injuries, or they're generally confused.
Again, this is why I'm not lining up to stone doctors and staff right away. Because there are so many factors that can go wrong. We've gotten mistakes that originated with the person admitting the patient(name spelled wrong, DOB wrong). Sometimes, the receptionist/secretary in the docs office books things wrong,or books for the wrong side.Sometimes both limbs, or eyes, or internal organs(kidneys ovaries, lungs) have issues, so it's not readily apparent which one needs the operation.
All of this is why I refuse to rush anymore..no matter how much anesthesia or the physician or management wants me to...I like what a previous poster said about crossing every T and dotting every I. Details are vital in this area. They can jump up and down and pitch a hissy fit all they want to. Also, I recommend malpractice insurance for any nurse working in this specialty. Because they will try to pin anything and everything on the circulator, unfortunately.
| | No. 26 |
Nov 08, 2009, 06:36 PM
Re: RI hospital fined $150,000 in 5th wrong-site surgery since 2007
The fine is way too low to matter to a hospital or even to the responsible surgeon(s), should he or she or they have to pay it.
And who does it go to? It won't be of help to the victims, I'm sure.
I guess the hospital is in bed with the "finer".
Yes, nurses must be made of steel to withstand the pressures from aides, bosses, doctors, patients and visitors, etc. We are really caught in the middle. Can you say "burn out"?
I hope the victims sue the living p@#@ out of these incompetent boobs. Squirrel, you're right - errors originate from many places. I think the answer is to have the patient's advocate - spouse, parent, whoever - right there with the patient, right up til the timeout is done correctly. Since the pt is doped and can't fend for himself, the advocate should be there. Ridiculous but promising.
| | No. 27 |
Nov 08, 2009, 09:21 PM
Re: RI hospital fined $150,000 in 5th wrong-site surgery since 2007
The bottom line to this whole issue is that they are sloppy. The surgeon of record is responsible for assuring that he/she is operating on the correct site. Therefore, if he/she has any common sense at all, he/ she will identify that body part with another person before surgery begins and document that fact. Any doctor who fails to do this deserves what he or she gets.
Now, the next issue is this. You get the patient on the table and ready and the surgeon is late. Do you wait for him to get there in order to identify the correct body part? If your smart you do. I have seen consent forms that don't even have the right body part listed in the consent.
The OR manager has to keep the OR moving. One late surgeon can screw up the schedule for the rest of the day. Plus you have to deal with attitude. The surgeons generally bring a lot of money into a hospital so CEO's are not generally inclined to kick them out for not following hospital policy, which is why they end up with a mess on their hands.
You CANNOT have other people being given total responsibility for identification of the surgical site. IT MUST INCLUDE VERIFICATION BY THE SURGEON OF RECORD. He/ she can actually do this the day before or when he sees the patient in the office by marking the area then.
There is simply no excuse for this situation. I guarantee you I would not be having surgery there.
| | No. 29 |
Nov 08, 2009, 10:52 PM
Re: RI hospital fined $150,000 in 5th wrong-site surgery since 2007 Originally Posted by diane227 The bottom line to this whole issue is that they are sloppy. The surgeon of record is responsible for assuring that he/she is operating on the correct site. Therefore, if he/she has any common sense at all, he/ she will identify that body part with another person before surgery begins and document that fact. Any doctor who fails to do this deserves what he or she gets.
Now, the next issue is this. You get the patient on the table and ready and the surgeon is late. Do you wait for him to get there in order to identify the correct body part? If your smart you do. I have seen consent forms that don't even have the right body part listed in the consent.
The OR manager has to keep the OR moving. One late surgeon can screw up the schedule for the rest of the day. Plus you have to deal with attitude. The surgeons generally bring a lot of money into a hospital so CEO's are not generally inclined to kick them out for not following hospital policy, which is why they end up with a mess on their hands.
You CANNOT have other people being given total responsibility for identification of the surgical site. IT MUST INCLUDE VERIFICATION BY THE SURGEON OF RECORD. He/ she can actually do this the day before or when he sees the patient in the office by marking the area then.
There is simply no excuse for this situation. I guarantee you I would not be having surgery there.
I was always taught that you don't bring the patient to the OR suite until they(the surgeon) are there. Have I had surgeons screaming at me over the phone because they want me to bring the patient to the room, even though they aren't in the building yet? Sure, but too bad, so sad, it ain't happening.
This happens everywhere though. Our local paper had an article about this when it first happened and it's happened at least once to most of the hospitals in the state. RI hospital is the only trauma facility in the state, and they get patients from surrounding states as well. Most hospitals, including mine, have to transfer pts there, because we are not level one. This is not an excuse of any sort, it's cold hard fact. We all have to realize that this can happen to anyone, at any time and if it means we go overboard with the rules, then fine.
And I realize that OR managers have to keep the schedule moving, but not at the expense of patient safety. These managers have to grow some *****, stand their ground, and back their staff.
I still feel that a lot of these problems could be avoided if the surgeon marks the pt in the holding unit and the patient isn't brought back to the suite until then. Pre-marking is not wise. Most of these pens/markers wear off somewhat..if there is premarking, it'll most likely not be visible by the time the pt comes in and certainly not after prepping.
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