Methods for reducing wrong-site procedures

Limitations

Standard pre-operative verification protocols on patient identity, surgical site and procedure (involving patients, their families, and the entire surgical team; cross-checking for consistency in consent form, medical record, operating room booking form, imaging results) combined with periodic audits and feedbacks

·       Lack of communication and cooperation between surgical team members and patients/families; among surgical team members

·       Any one person or record may make or contain an error in identification, so must verify with all parties and documents

Verification checklist completion before start of procedure and immediate resolution of discrepancies found during verification process

·       Skipped steps due to interruptions and distraction

·       Checking an item as complete when it has not been

Requirement for active surgical team timeout immediately before start of procedure for final confirmation of patient identity, surgical site and procedure

·       Fails to address unavailability of team members and equipment, and varying roles

·       May add more work and encourage work-arounds that undermine the effectiveness of time-outs

Marking the surgical site with an indelible marking pen after verification

·       Possibility of surgical field infections

Barcoded patient wrist bands or surgical smart chips placed near surgical site which are scanned pre-operatively/perioperatively and verified to confirm patient identify, surgical site and procedure

·       Cost and technological barriers to implementation

Event reporting (e.g., Sentinel event policy by JCAHO) followed by root cause analyses and risk reduction plans

·       Under-reporting

·       Inaccurate or ambiguous reporting

·       Inadequate resources for analyses and risk reduction plans