Correct Site Surgery © Association for Perioperative ...
Transcript of Correct Site Surgery © Association for Perioperative ...
Correct Site Surgery © Association for Perioperative Practice 2006
Second check to be made by ward/day care staff prior to patient leaving ward/day care area:
inspect mark against patient’s supporting documentation – patient’s notes, consent form, patient’s I.D. band
ensure availability of relevant imaging studies in operating theatre/suite
Third check to be made by operating surgeon or competent nominateddeputy in anaesthetic room prior to anaesthesia:
inspect mark and check against supporting documentation – patient’s notes, consent form, patient’s I.D. band
re-check imaging studies
check availability of correct implant (where appropriate)
Final check to be made by the entire team. Surgical, anaesthetic and theatre team pausebefore commencing surgery for everyone present to confirm:
presence of correct patient
marking of the correct site
procedure to be performed
First check to be made by surgeon or competent nominated deputy to be present at operation:
check patient’s identity band or ask patient to identify themselves – name and date of birth. Involve patient/family member/significant other
check reliable documents/image for intended surgical site – patient’s notes and consent form
mark with an indelible pen using an arrow at or near the intended incision. For digits the arrow should extend to the correct specific digit(s)
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2
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4Circumstances where marking maynot be appropriate:
emergency surgery should not be delayed
surgery on teeth or mucous membranes
bilateral procedures such as tonsillectomy and squint surgery
situations where laterality of surgery will be confirmed during the procedure
If a patient refuses preoperative skinmarking local policy should be followed but include:
document patient’s request in the nursing and medical notes
complete correct site surgery checklist but clearly state patient refuses marking. This will ensure staff are aware at each stage of the process
managing the risk
Cor
rect
Site
Sur
gery
man
agin
g th
e ri
skCo
rrec
t Si
te S
urge
ry –
the
err
ors
we
know
abo
ut
Janu
ary
2000
a m
an in
Car
mar
then
shire
die
s af
ter
wro
ng k
idne
y re
mov
ed.
Mar
ch 2
006
a he
alth
y ki
dney
was
rem
oved
fro
m a
man
in A
yrsh
ire.
May
200
6 G
ener
al M
edic
al C
ounc
il (G
MC
) he
arin
g re
gard
ing
a su
rgeo
n w
ho r
emov
ed a
pa
tient
’s t
rans
plan
ted
kidn
ey in
stea
d of
her
nat
ural
one
.
Ana
lysi
s of
the
abo
ve in
cide
nces
fou
nd t
hat
syst
em f
ailu
res,
def
icie
ncie
s in
the
pro
cess
and
lack
of
robu
st v
erifi
catio
nch
ecks
left
the
patie
nt a
nd s
urge
on v
ulne
rabl
e.
Corr
ect
Site
Sur
gery
– t
he f
acts
we
wan
t to
cha
nge
Wor
k by
the
Nat
iona
l Pat
ient
Saf
ety
Age
ncy
(NP
SA
) ca
lcul
ates
tha
t th
e er
ror
of w
rong
site
su
rger
y oc
curs
app
roxi
mat
ely
400
times
a y
ear
with
in t
he U
K N
atio
nal H
ealth
Ser
vice
(N
HS
).
Sur
gery
per
form
ed o
n th
e w
rong
site
or
the
wro
ng p
atie
nt is
rar
e bu
t su
ch m
ista
kes
have
dev
asta
ting
cons
eque
nces
for
the
patie
nt.
Del
iver
ing
safe
pat
ient
car
e is
fun
dam
enta
l to
the
role
of
all t
he s
urgi
cal m
edic
al a
nd n
on-m
edic
al t
eam
. The
NP
SA
foun
d th
at a
cros
s th
e N
HS
the
re w
as n
o si
ngle
sta
ndar
d m
etho
d fo
r m
arki
ng a
sur
gica
l site
, th
eref
ore
incr
easi
ngth
e ris
k of
mis
take
s by
inco
nsis
tent
ver
ifica
tion
of t
hat
patie
nt b
y st
aff.
The
impo
rtan
ce o
f sa
fe c
heck
ing
proc
edur
es le
d th
e N
PS
Aan
d R
oyal
Col
lege
of
Sur
geon
s (R
CS
) to
pub
lish
reco
mm
enda
tions
for
sur
gica
l mar
king
and
to
prod
uce
a st
anda
rdis
ed c
heck
list
to p
rom
ote
Cor
rect
Site
Sur
gery
.
The
fol
low
ing
guid
elin
es h
ave
been
dev
elop
ed t
o en
able
per
iope
rativ
e pr
actit
ione
rs a
nd s
urgi
cal w
ard
staf
f to
use
pr
eope
rativ
e m
arki
ng r
ecom
men
datio
ns t
o en
sure
tha
t th
e co
rrec
t pa
tient
has
the
cor
rect
ope
ratio
n at
the
cor
rect
site
.
The
Ass
ocia
tion
for
Per
iope
rativ
e P
ract
ice
(AfP
P)
ackn
owle
dges
the
con
trib
utio
n of
Dia
ne G
ilmou
r, S
urre
y an
d S
usse
xH
ealth
care
NH
S T
rust
, P
eggy
Edw
ards
and
the
NP
SA
for
thei
r he
lp in
for
mul
atin
g th
is g
uida
nce.
Refe
renc
es a
nd F
urth
er R
eadi
ng
Ass
ocia
tion
of A
naes
thet
ists
of
Gre
at B
ritai
n an
d Ir
elan
d 20
03 T
heat
re E
ffic
ienc
y:sa
fety
,qua
lity
of c
are
and
optim
al u
se o
f re
sour
ces
Lond
on, A
AG
BI
Ass
ocia
tion
for
Per
iope
rativ
e P
ract
ice
2006
Ris
k an
d Qu
ality
Man
agem
ent
Syst
em H
arro
gate
, AfP
P
Com
mis
sion
for
Hea
lth I
mpr
ovem
ent
2000
Inve
stig
atio
n in
to C
arm
arth
ensh
ire
NHS
Trus
t W
ales
, C
HI
Edw
ards
P20
06 P
rom
otin
g co
rrec
t si
te s
urge
ry J
ourn
al o
f Pe
riop
erat
ive
Prac
tice
16 (
2) 8
0–86
Nat
iona
l Ass
ocia
tion
of T
heat
re N
urse
s 20
04 N
ATN
Stan
dard
s an
d Re
com
men
datio
ns f
or S
afe
Peri
oper
ativ
e Pr
actic
eH
arro
gate
, N
AT
N
Nat
iona
l Pat
ient
Saf
ety
Age
ncy
2005
Pat
ient
Saf
ety
Aler
t 06
Lond
on,
NP
SA
http
://w
ww
.saf
erhe
alth
care
.org
.uk
http
://w
ww
.nps
a.nh
s.uk
Ass
ocia
tion
for P
erio
pera
tive
Prac
tice
ww
w.a
fpp.
org.
ukD
aisy
Ayr
is H
ouse
, 6
Gro
ve P
ark
Cou
rt,
Har
roga
te,
HG
1 4D
P
Tel:
+44
(0)
1423
508
079
Fax
: +
44 (
0)14
23 5
3161
3
Correct S
ite Surgery
managing the risk
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