Patient Safety Tool: 3 Surgical Error Analysis Forms

The Pennsylvania Patient Safety Authority offers three free forms to aid in analysis of wrong-site, wrong spinal level and wrong ureter surgeries.

The wrong-site surgery error analysis form, which was published in 2008 and revised in 2010, is designed to help healthcare leaders identify the causes of and contributing factors to the error. The form includes questions about all aspects of the error and surgery:

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•    The type and extent of the error
•    Patient characteristics
•    Surgery characteristics
•    Scheduling
•    Operating room consent documentation
•    Preoperative verification
•    Marking the operative site
•    Time-out
•    Intraoperative specimen handling
•    During operation
•    Education/training
•    Communication issues/culture

The wrong spinal level and wrong ureter analysis forms also ask questions to determine causes of the error. They were published in December 2009 and March 2010, respectively, as addendums to the main wrong-site surgery analysis form.

Download the wrong-site surgery error, wrong spinal level and wrong ureter analysis forms for use in your own facility.

Note: View our database providing more than 400 reports that link to free downloadable and adaptable tools for use in surgery centers, hospitals and other organizations.

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