Wrong site surgery - how to prevent

[Sunnyday2235]

what procedures does your organization have in place to prevent wrong site surgeries? i'm curious about the variation in protocols from hospital to hospital.

thanks!

[Mr. & Mrs. RN]

We also require the surgeon to complete an H & P prior to entering the surgical suite. It's not always ready for viewing if it hasn't been transcribed, but for regular scheduled cases, we compare our consent to the H&P. It must state that the surgeon discussed risks, alternative with the patient and state the correct side if it involves a right vs. left. We also have the x-ray or scan up in the room to compare.

[wakyone]

We struggled with site marking for ureteral stones. We tried marking inner thigh since marking should be visible after draping-surgeons refused to go under the blankets to mark patients. Finally after a few more ideas, we settled on a blank wristband to be placed on the arm of the side of the stone. Visible when timeout is done and after draping. So far, working well

[MsLeylaBar]

We do timeouts in our facility the way GadgetRN said.

The surgeon is responsible for initiating it. Everyone in the room stops and gather around the patient. We actually all introduce ourselves first and state our roles before reading the patient's armband and comparing it to the consent. We are a teaching facility so we always have so many different kinds of students or observers in our OR. We discuss the consent, laterality, look at xray, mark on the patient, what equipment we need, antibiotics needed, anesthesia plans, DVT prophylaxis, where the patient is going after surgery, recovery room or ICU direct etc.

[RNOTODAY, BSN, RN]

All of the above AND we recently changed to the SURGEON initiating the timeout. Consent open, full blown everyone involved. If the surgeon balks they get talked to by surgery exec committe, then they behave:yeah:

There are still a couple times when we all can forget but it has worked out very well. Marking that can be seen after prep is also a BIGGIE.

I like this idea.... the nurse is the heavy on soo many things, it would be nice to have the surgeon initiate the t/o....I still cant understand what their problem is with the timeout, it only take a minute, do they consider it an insult or something? Why do they give us so much crap about it???

[Rose_Queen, BSN, MSN, RN]

Our policy is that the circulating RN is to initiate the time out. Probably the reasoning is that the surgeon is already at the field, and we are supposed to read word for word from the consent. Also, none of our surgeons, with the exception of trauma (where half the time we don't even have the complete info for time out), are hospital employees.