Safety guidelines factor in preventing surgical errors

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Published: July 12,2004

If you’ve ever been on an operating table and wanted the attending nurses and physicians to make one last safety checklist to make sure they have the correct patient and procedure, you’re not alone. As of July 1, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has issued new guidelines aimed at reducing surgical errors.

That organization is just one more group joining the effort of medical organizations to reduce surgical errors, says Dr. William Turner Jr. of University of Mississippi Medical Center (UMC) where surgical safeguards have been in place for a number of years.

“We’ve been working constantly through various entities to achieve consensus on patient care guidelines,” he said. “There are a lot of sources, and this one is the latest group to join an issue that’s been discussed for a long time.”

The guidelines require physicians and surgical staff to perform the following tasks prior to surgery:

• Surgeons must sign the incision site, ideally when the patient is awake and cooperative, with a marker that will not wash off in the operating room.

• Operating teams must complete a checklist before the surgery to ensure the correct patient is on the operating table.

• Operating team members must agree on which procedure is being done and on which part of the body.

Any hospital or surgical facility not complying with the new safety rules risks losing JCAHO accreditation. Turner said UMC is already in compliance and will not be affected by this threat, although any hospital’s loss of accreditation could have an adverse effect on federal funding.

An official at the Mississippi Hospital Association (MHA) says none of their 115 member institutions are in danger of losing accreditation either.

“Standards that are a part of the new guidelines have been in place for several years,” said Marcella McKay, vice president for nursing and professional affairs with MHA. “Hospitals have been aware and have been complying. All of these guidelines have been recommended in the past and now they’re mandatory.”

McKay says her organization has been surprised at the attention the statement from JCAHO has generated. She feels the national focus on patient safety is a factor in making the guidelines more universally known.

“We’re pleased any time the efforts of hospitals to increase patient safety are publicized,” she added.

Turner, who is James D. Hardy professor and chairman of the surgery department at UMC, says the public discourse and dissemination of information on this issue is a very good thing.

“Having this information in the lay press will help patients understand why we do these things,” he said. “We’ve had some concern from patients when a surgeon marks the incision site before the surgery. They think the surgeon might not know what he’s doing.”

He points out that for many years plastic surgeons have been using markers on patients to outline procedures that are to be done. Any public information that helps patients understand the extended use of this safeguard in other surgeries is positive.

“With the World Wide Web, patients are able to have access to the medical profession’s discourse and obtain more information,” Turner said.

In addition to marking the incision site, surgical teams at UMC have operative time outs to identify the patient and what’s to be done before the procedure starts and have a post operative to agree on who the surgeon was and what specimens were removed.

“Most hospitals have had some type of guidelines in place for years in various formats and it has helped,” Turner said. “They’re considered best practices in hospitals.”

No one knows exactly how many wrong surgeries occur because JCAHO receives only voluntary reports, but they are thought to be a small fraction of the nation’s 70 million annual surgeries.

Contact MBJ contributing Lynn Lofton at mbj@msbusiness.com.

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