Wrong-site surgeries are on the rise, and they are not only devastating to patients but also costly to healthcare facilities as a growing number of insurance companies are no longer providing reimbursement for preventable medical errors.
Jeff Lynch of Viscot Medical, a provider of disposable medical products, warns against the following five common, but critical, surgery safety mistakes.
1.The surgery site mark is ambiguous. "There is a requirement by The Joint Commission (as an element of its "Universal Protocol" for preventing wrong site, wrong procedure, wrong person surgery) that patients or hospital staff mark where they are going to have surgery," Mr. Lynch says.
"Many times, whoever ends up making the mark is just making an 'X' on the area and not providing any identification," Mr. Lynch says. "The surgeon or nurse should be putting their initials or the word 'yes' where the incision is going to be made to avoid confusion or mishap."
Mr. Lynch says that in a large healthcare facility, especially one that has large volumes of patients, it is easy for mix-ups to occur, especially when a surgeon is operating on one patient after another.
"Site verification," Mr. Lynch says, "should involve the patient as well as the surgeon and appropriate nursing staff. The mark should be made near the procedure/incision site and should be unambiguous and following a consistent marking protocol."
2. An incorrect marker is used. "The biggest pitfall we see is that the wrong marker is used to make mark," says Mr. Lynch.
"Although gentian violet is the ink which is approved by the FDA, we find many different markers are used (i.e. ballpoint pens)," Mr. Lynch says. "This results in the ink coming off when the patient is prepped."
"We recommend the use of an alcohol swab on the patients skin that will be marked," he says. "The alcohol swab removes the oils of the patient's skin and allows gentian violet ink to absorb slightly into the skin, making the ink scrub resistant. Although the gentian violet ink already has alcohol and antiseptic in it, the oils in skin can cause the marker to smear. The alcohol is an extra precaution."
3. The marker is reused. Mr. Lynch strongly encourages single patient use for skin markers.
"Although gentian violet ink is an antiseptic, the marker could potentially pass bacteria from one patient to another if it were reused," he says.
4. The preoperative verification process is rushed. "Another major issue is time," Mr. Lynch says. "You need to [allow for the] right amount of time for the marking procedures, sitting and talking to the patient and passing information to the nurses or surgeons."
"One of the top reasons wrong-site surgeries occur is because people are rushing and not allotting the right amount of time to preoperative procedures," he says.
Mr. Lynch says communication is critical across the continuum of surgical care.
"Surgeons and nurses need to be talking prior to the case," he says. "The patient needs to be aware of everything that is going to happen and why they are being marked. Increasing communication will significantly reduce wrong-site surgery."
5. Similar mistakes are made with medication labels. The Joint Commission also spells out requirements for use of medical labels that organizations often forget to follow, Mr. Lynch says.
"One of the big issues is hospital staff put a paper-based label on a syringe and then put it a bowl of solution," he says. "Those saline solutions cause the paper to disintegrate, which then makes the label hard to read. Furthermore, the label can fragment and then come in contact with the patient's body."
"Another major issue is the fact that clinicians mark labels with skin markers, which are great for skin but not for other surfaces," Mr. Lynch says.
Labels marked with the skin markers run and medication mishaps may occur because hospital staff cannot read the labels.
Mr. Lynch says that the best way to comply with The Joint Commission requirement to label medication on and off the sterile field is through the use of pre-printed medication labels. He says that it is preferable if the label is synthetic, but "if the facility insists on writing labels, then a waterproof marker or dual tip marker should be utilized to ensure that the labels don't smudge or smear when wet," he says.
Jeff Lynch (jeffl@viscot.com) has spent the majority of his career working for medical supply companies. Viscot Medical is a provider of disposable medical products including items like pre-surgery skin markers and sterile waterproof medication label kits which are used in ASCs, hospitals and many other types of facilities. Learn more about Viscot Medical.