Time-Out/Surgical site marking....

lindaloo51 · Feb 18, 2005

Initially, we had some resistance to the time out policy. Lucky for us that most of the Docs were on the band wagon and were helpful and encouraging. Also, now we have added to our OR permits a check list that the circulator initials that documents all of the necessary information that is communicated during time out. The biggest problem that I have seen at our institution is that Pre-Op being in a hurry doesn't always want to wait for the patient to mark their own site.(The elderly or handicapped)

At first, we did have a few docs that were hold outs, but I found that I could cut off their tirade by saying that I already know that you don't want to hear this, but my boss says that I have to do this.

The great news is : THIS REALLY WORKS!!!!!!!! We have had at least one occasion where the rep had brought the wrong implants for a revision. Time out caught it and prevented a potential disaster in the middle of a difficult procedure.

nurselily3 · Feb 18, 2005

We have been doing "time out" at our hospital for almost a year now. We had a few problems with getting some of the surgeons on board, but all has worked out at the end. They think its a game now to beat the circulator or anesthesia in calling the time out....such children.

Marie_LPN, RN, LPN, RN · Feb 18, 2005

We've had a heck of a time getting our docs to mark the site. In the time it takes for them to ***** about marking it, they could have had it marked 8 times over.

mcmike55 · Feb 18, 2005

We have been doing time outs for more than a year, I think.

We had troubles at times with some of the docs. they made fun of it, didn't take part, etc. Now they are the ones that start the time out if we forget! :chuckle

Site marking is sometimes a problem. We use a skin marker, and have had some issues with laterality especially like on kidney stones we are doing thru the cystoscope, and things like that. We have the pt or family mark it, or have the pt direct the nurse do it. Right now the surgeon does not mark the site, but it is in plain site after the prep and drape.

One issue we had was that it seemed like everyone waited for the circulator to call it, and sometimes we were so busy, we didn't do it....it wasn't long before the message got around that anyone in the room could call it.

We are now working on doing a better job marking meds on the field. Prior to this, if we only had one med on the field we didn't mark it, but are changing.

Trying to mark irigation and splash basin fluids too.

Mike

Cookie@50 · Feb 20, 2005

In our facility the actual policy was written that the site had to be marked but nothing specfic was written as to who, what, and where. We had a mini checklist inserted in our perioperative nursing record. Our director went on sick leave which left everyone doing time out in their own way. Circulators were marking the site when the patient got to the OR which wasn't supposed to happen. Finally the policy was fixed and the preop holding room nurses assist the patient in marking the site. We use the letter "C" for correct site. th eonly problem was getting technicians to realize the importance of verifying the correct site. They are not used to reveiwwing the chart and/or asking the patient. Can anyone let me know how techs verfy the site in your facility?

Marie_LPN, RN, LPN, RN · Feb 20, 2005

We require that the doctors use their initials.

tntrn, ASN, RN · Feb 20, 2005

I'm sure it is helpful in an OR, but in our OB unit, where the ONLY surgery we do is the c/section, it is a PIA. But anything to keep the JCAHO people employed.

carcha · Feb 21, 2005

This sounds great!. Can anyone explain the time out ect to me please.

chip193 · Feb 22, 2005

Our facility requires that we use a "time out" for any procedure where the physician obtains a specific consent form (LPs, reductions, etc.).

It can be a pain in the rump - especially when we have docs that go and do LPs without telling us that he's on the way to do it!

Chip

ShirleyM · Feb 25, 2005

Carcha,

The timeout/surgical site marking comes from National Patient Safety Goals established yearly, I believe by JCHAO. One of the goals is to eliminate wrong site surgery/laterality/procedure/patient. Before the patient has a procedure of any kind, whether in the OR or anywhere else in the hospital the patient must be marked where the surgery/procedure is to be done. According to JCHAO, the site must be marked with a 'yes'. My understanding is that that came about after reports of wrong site surgery where the surgeon mistook the former indicator (an x) as a do not operate, thus doing surgery on the wrong side. The marking must remain after skin prep and drapes are applied. There are exemptions to this. If the incision is on a body orifice(i.e, cystoscopy) then no marking is needed, but it you're doing say, a cysto with a right stent placement, then the right side must be marked with 'yes'.

The timeout must be done before surgery begins. It does not involve the patient but can be initiated by anyone. Timeout is a verbal confirmation in the OR of the patients identity, procedure, laterality if applicable, patient positioning and special needs including implants.

If I'm leaving anything out, please drop a line everyone.

rcsc · Mar 4, 2005

In my esperience administration, some staff, and physicians have not taken it seriously enough. What is said in meetings and prcaimed in the policy is not being done, BUT no one talks about it - staff nurses are aftaid to confront this. I believe that it is not possible to legislate ethical behavior. It is always easier to complain and grumble about "one more thing to do" or "hey - with some of our docs it will never happen."

Am I distressed about it? Yes, however I think that patient education will be the best way to address this - when patients start asking - "I thought you were supposed to mark where you do the surgery?" Ther might be more compliance.