Washington, DC -- Preventing surgical errors begins long before a patient enters the operating room and requires instituting some fairly simple routines, such as utilizing checklists, eliminating distractions, and designating the actual surgical site on the patient with a marker, says The American College of Obstetricians and Gynecologists in recommendations issued today. Actively involving the patient before surgery also is an essential element in avoiding errors during surgery.
According to The Joint Commission, there were 116 wrong-site surgical errors in the US in 2008. Wrong-site surgeries are operations on the wrong-side of a patient, the wrong organ, or the wrong patient. Some common circumstances that increase the risk for surgical errors include having multiple surgeons involved, multiple procedures being performed on the patient at the same time, patients with unusual physical characteristics (such as morbid obesity or a physical deformity), and time pressures to start or complete the surgery.
"It's fair to say that communication failures between surgeons and the rest of the health care team is a frequent theme in why many if not most surgical errors occur," said Patrice M. Weiss, MD, chair of The College's Committee on Patient Safety and Quality Improvement. "We're highlighting the common situations that raise the risk of surgical errors and offering concrete steps to prevent them. We hope that physicians will utilize these preventive measures to protect their patients."
The Joint Commission's three-part universal protocol to prevent surgical errors is one useful tool for health care teams, says The College. The first component entails having the health care team ensure that all of the patient's relevant documents and all of the surgical equipment is available, correctly identified, and reviewed before surgery. The second element entails marking the incision or insertion site of the surgery. Calling a "time out" before the surgery begins for the health care team to confirm the identity of patient, the surgical site, and the indicated surgery is the third protocol component.
"Using standard checklists, systems, and routines may sound to some like cook-book medicine, but they have been proven to greatly reduce surgery errors," said Richard N. Waldman, MD, president of The College. "Airplane pilots routinely use checklists to reduce risks and improve safety—why shouldn't physicians?"
Another useful tool to enhance patient safety is a checklist published by The World Health Organization (WHO), said Dr. Weiss. The checklist allows surgical teams to review routine items and procedures before they administer anesthesia, before they make the first incision, and again before the patient is wheeled out of the operating room. The WHO maintains that errors can be reduced when the entire surgical team verifies the incision site and that any team member should be encouraged to point out a possible error without fear of being reprimanded or ridiculed.
Surgeons and other members of the health care team should be alert and well-rested before a major surgery because excessive stress and fatigue are a recognized source of human error, says The College. Eliminating or minimizing all distractions in the operating room is also important in reducing surgical errors. These distractions include beepers, cell phones, radios, and nonessential conversations among the health care team. "The presence of people in the operating room who are observing but aren't involved in the surgery should be evaluated for the value to the observer and balanced with the need to minimize distractions," said Dr. Weiss.
These patient safety recommendations apply not only to hospitals, but also to surgeries performed in physicians' offices, freestanding surgical facilities, and surgicenters, according to Dr. Weiss.
Committee Opinion #464, "Patient Safety in the Surgical Environment," is published in the September 2010 issue of Obstetrics & Gynecology.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org
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