Wrong side/omitted procedure

goats'r'us, ASN, RN · Jul 10, 2012

i can tell you exactly why this happened. time is money.

my hospital has a policy that before the patient can be brought up from the waiting bay to the anaesthetic room, the surgical site must be marked and initialled by the surgeon, and the consent must be signed. If this has not been done, the anaesthetic nurse cannot bring the patient up, therefore the anaesthetic reg cannot begin doing anaestheticy things like putting in lines while the consultant finishes up the previous case, which increases changeover time.

so, technically, if there is a signed (albeit incorrect) consent, the nurse can bring the patient up to start non-sedatey anaesthetic stuff, rather than waiting for the surgeon to finish the case and make their way down to correct the situation. it's not like they're going to medicate the patient or anything, right? and the patient can talk still talk to the surgeon in the anaesthetic room, so where's the harm?

so wrong!!

policies are in place for a reason, and basically this nurse is bending the rules to save a bit of time wastage and reduce hassle for herself.

one of the reasons why my hospital has this policy is that it's been decided that when the patient's already got changed, waited in the waiting bay, been checked through to the anaesthetic room and essentially had their anaesthetic started, their consent is no longer being given freely and without pressure.

bottom line. the nurse should 1) not be consenting you in the first place, that's the doctor's responsibility, 2) the nurse should not have allowed you to progress through to the anaesthetic room with an incorrect consent (and she knows it), and 3) stand up for yourself - you shouldn't have signed the incorrect consent form (and you know it!).

Heart2015FNP · Jul 10, 2012

I would suggest reading all the replies and you would notice that the common theme is " why did you sign the consent." Regardless of the fact that I've been a member of one month, you had seven years of membership or five years as a nurse to realize that you have to be an advocate. If you can't advocate for yourself, then how can you do for others. That was my source of frustration. Seek your answer with the Director of Surgery at the facility...not here. Enough said.....done with the entertainment.

fallinnstyle · Jul 10, 2012

I would suggest reading all the replies and you would notice that the common theme is " why did you sign the consent." Regardless of the fact that I've been a member of one month, you had seven years of membership or five years as a nurse to realize that you have to be an advocate. If you can't advocate for yourself, then how can you do for others. That was my source of frustration. Seek your answer with the Director of Surgery at the facility...not here. Enough said.....done with the entertainment.

OP stated she was in pain, and wanting to be out of pain won out above all other sensibilities or nursing knowledge. She was in fact a patient and the responsibility was on the OR nurse to act as the patient advocate.

You should never expect any of your patients to have more knowledge than they have received from you or the rest of the medical professionals during their stay. If you the OR nurse informed the patient than she can not speak to the surgeon until she signs the consent, most patients will believe you and also believe than you will not let anything bad happen.

Seeking advice here from OR nurses is a way for the OP to verify that this is not the usual MO in the OR, and receive good direction as to whom she should direct her concerns to. I believe she has received great direction.

Finally, it would not have been entertainment to see the OR nurse and surgeon dancing on the witness stand, explaining why a wrong site surgery was performed.

Daqueengene · Jul 10, 2012

I cannot imagine WHY A NURSE WOULD REQUIRE YOU TO SIGN A PERMIT THAT YOU INDICATED WAS NOT CORRECT!!!!!!!!

Having said that I am appalled and embarrassed by the lack of professionalism and disregard of patient safety and the WHO, Joint Commission, AORN ,ect... emphasis on correct site surgery. I cannot imagine this happening! I would bring this up to the management of the hospital or surgery center where you had your procedure. I would caution that you should never sign a permit that is incorrect EVER no matter what anyone tells you.

CIRQL8 · Jul 10, 2012

The nurse who initially refused to send you along until you signed the wrongly worded consent was (unfortunately) doing what she thought that she was supposed to do. And if not, she was certainly being lazy. I do agree that the consent should have been rewritten correctly PRIOR to your signing it. The nurse could have had the physician paged even if she could not send you on.

How often does something like this happen? I don't know. Once is too many. Unfortunately, it is not uncommon; although, thankfully, it is rare.

I am appalled at some of the personal attacks towards you. I think that every nurse in this forum has at one time or another been intimidated by a physician or other medical professional. Either as the nurse, as the patient, or as the family. Anyone that states otherwise is either in denial or a liar. It has happened to me. It is currently happening to my uncle. And he IS A physician. He is being screwed around by the system and either has no way around it or doesn't know the way around it.

This is a forum for information and/or for support. Personal attacks really have no place here.

Sent from my iPad (so excuse any typos and autocorrects!!) using allnurses.com

OnlybyHisgraceRN, ASN, RN · Jul 10, 2012

I would suggest reading all the replies and you would notice that the common theme is " why did you sign the consent." Regardless of the fact that I've been a member of one month, you had seven years of membership or five years as a nurse to realize that you have to be an advocate. If you can't advocate for yourself, then how can you do for others. That was my source of frustration. Seek your answer with the Director of Surgery at the facility...not here. Enough said.....done with the entertainment.

You need to realize that these things happen and get your head out of the sand. It was NOT entertainment when it was found that my patient had a sponge left inside of him after surgery. No nurse is perfect. Even though coworkers blamed the OR nurse and criticized her, I did not. I realized she is human, however it was a big teaching moment. Part of sticking together is catching eachother when we fall.

The OP was a pt. not a nurse. There have been several times when I didn't advocate for myself while being hospitalized, was in a different mindset.

pgotm · Jul 10, 2012

i work in risk management, and cringed the whole time, reading your post. unfortunately i'm sad to hear that you gave in and signed the consent. imagine a patient in the same position doing that, and along the way, communication was broken, and another patient became and rapid response, and your nurse responded. during all the chaos, of helping that patient, she forgot about telling you that a new consent would be seen. your wheeled in to the or, and next thing, you have a wrong site surgery. you signed the consent for the surgery, validating that indeed that was the correct surgery to perform. you were aware of the risks and benefits. the surgeon and the hospital have very good high priced lawyers, that will do everything to protect them. i would speak with the risk management office and administration at the facility you were at. there are serious issues. i would hope that the md had informed you of the risk and benefits, and that the anesthesiologist, had come to speak with you first, before consent was signed. then that the correct site was marked prior to any narcotic, or anesthesia. joint commission has checklists, that facilities should tailor to their needs, that were invented to prevent these type of incidents.

Esme12, ASN, BSN, RN · Jul 10, 2012

When you are a patient it is amazing that while you can advocate for complete strangers......it is difficult to advocate for yourself. You are worried that you will one of "Those patients" or "another one of those (insert eye roll) medical people who think they know it all". We can be intimidated as well as any other patient. Heck, we intimidate each other even when we are work.

You don't want to offend or seem pushy because you don't want to be talked about at the nurses station (we all know we do). You are frightened, medicated and in pain. You want to please so that you will get good care and have your call light answered (for we all know about postponing that annoying pain in the butt call light). Nurses are unfamiliar with being in that vulnerable position and it makes us uncomfortable.......sometimes we don't know how to act and shut down. Would you want to make the staff that is going to care for you angry that is going to care for you while you are asleep?

Before you judge how and why someone acts the way they act......remember you really don't know until you walk in their footprints and see it from their point of view.

Different hospitals have different policies....that is why, to this very day, stupid life altering mistakes occur to innocent patients. Regulations are developed because people do stupid things to cut corners or just because they don't know better. We are so quick to judge that "I wouldn't do that" and "How can that be?" When in fact.....even within a 20 mile radius policies vary on whether or not nurses can sign consents. Some say the are witnessing just that patient signature and they are still doing it today. Some places require a separate blood consent while others include it on the surgical/admission consents.

Because of these different policies that vary so greatly is why regulating agencies try to get everyone on the same page.....which, unfortunately, usually fails....when you are dealing with the general public, big egos/CEO things will happen because everyone "knows better".

I think we can disagree with each other without being disagreeable or mean. AN like a lively debate but your disagreement needs to be polite. Personal Attacks will not be tolerated and are in violation with the Terms of Service.

We promote the idea of lively debate. This means you are free to disagree with anyone on any type of subject matter as long as your criticism is constructive and polite. Additionally, please refrain from name-calling. This is divisive, rude, and derails the thread.
Our first priority is to the members that have come here because of the flame-free atmosphere we provide. There is a zero-tolerance policy here against personal attacks. We will not tolerate anyone insulting other's opinion nor name calling.
Our call is to be supportive, not divisive.

I agree the OP should have probably not signed the consent until it was corrected but the nurse who told her it was ok would be the catalyst for the beginning of the error and wrong site surgery.

OP I am glad everything turned out OK.....I wish you a speedy recovery.:loveya:

mmm333, LVN · Jul 10, 2012

You could have said, "I'll sign it if you sign on there first and put your license number there". Then write "signed under duress and protest" under your signature. Haha, seriously, you already knew the answer to this question before you let yourself be manipulated by this automatonic nurse who couldn't be bothered to think outside the box! For certain some nurses might roll their eyes and think it's a big pain in the orifice, but you can't afford to care what they think because the stakes are too high. It's possible that the nurses there were afraid of the surgeon or surgeons- I've seen surgeons with filthy mouths screaming at staff all day long and nurses scared witless to speak up for fear of losing their job- this is in places where abuse is tolerated because they can't recruit enough good surgeons or in places where the surgeons go golfing with the administrators and have the clout to get staff members they don't like fired at their whim.

CrunchRN, ADN, RN · Jul 10, 2012

I wouldn't of signed it. No way. I would have had them fill another one out with the right side indicated and then I would sign.

Goobstress · Jul 11, 2012

I don't think she's looking for attention because I have seen this kinda thing happen and as recent as July 6, 2012. As an O.R traveling nurse sometimes I am amazed how certain hospitals operate and allow this kind of behavior in order to facilitate their schedule. Always in a hurry to finish an assembly line of patients on their surgery schedule. I believe her because I see this type of bad habit in hospitals especially in ones that don't require their patients to be marked prior to surgery or the ones that medicate the patient prior to speaking with the surgeon. Really scary stuff and although we don't believe it is common practice it still occurs in plenty of hospitals and even Magnet status hospitals.

Anxious Patient · Jul 11, 2012

To avoid delaying or cancelling the operation, could the patient correct the consent form themselves by scratching out and rewording it for accuracy, then initialing the change? Would that be legally acceptable?