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The Need for Surgical Preparation
PA PSRS Patient Saf Advis 2005 Mar;2(1):27. 
 

Surgeons understand the need to be properly trained to do a procedure. They also understand the need for a preoperative “time out” to verify that the correct patient is getting the correct procedure on the correct part of the body. However, preparation includes more than training and “time outs.” Consider these recent reports to PA-PSRS:

Case #1: A surgeon scheduled a patient for elective closure of a cranial defect from prior surgery. The surgeon brought prosthetic material to the operating room for the closure, but it was material suitable for temporary closure only, not permanent closure. The error was recognized before the operation began, and the procedure was cancelled and rescheduled.

Case #2: A patient with an acute left femoral artery occlusion was brought to the operating room after confirmatory angiography. The consent for thrombectomy, obtained as an emergency by someone other than the surgeon, erroneously listed the wrong leg. The pre-operative “time out” was done with the surgeon, but based on the incorrect consent. While making the initial incision, the surgeon remembered that the occlusion was in the left leg. To reconcile the conflicting information, he had the films brought to the operating room. The films confirmed his recollection, so he closed his skin incision and proceeded to do the thrombectomy on the correct leg.

Case #3: A surgical patient was kept under general anesthesia for two hours before their operation was begun. During this time the surgeon was on the phone with the technical representative of a medical device manufacturer. According to the facility’s report, the surgeon was “trying to figure out how to use [the] Neuro Navigator system.”

Preoperative preparation by the surgeon may need to go beyond verifying the consent and the correct patient, the correct procedure, and the correct site. A comprehensive preoperative checklist could also include:

  • Re-assessment for recent changes in the patient’s condition.
  • Verification of the indications for the operation with adequate information about the extent and exact location of the pathology available in the operating room for possible intra-operative decision making.
  • Review of the patient’s other medical conditions, allergies, and medications, including medications at the time of surgery, such as prophylactic antibiotics.
  • Confirmation that essential materials, such as blood products, implants, or prostheses, are available.
  • Confirmation that essential equipment is working properly.
  • Discussion with the team of possible intra-operative complications and how they should be managed.
 
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The Need for Surgical Preparation



THE PENNSYLVANIA PATIENT SAFETY AUTHORITY AND ITS CONTRACTORS  
PSA LOGO The Pennsylvania Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error (“Mcare”) Act. Consistent with Act 13, ECRI Institute, as contractor for the Authority, is issuing this publication to advise medical facilities of immediate changes that can be instituted to reduce Serious Events and Incidents. For more information about the Pennsylvania Patient Safety Authority, see the Authority’s Web site at www.patientsafetyauthority.org .      
ECRI LOGO ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research in healthcare to uncover the best approaches to improving patient care. As pioneers in this science for more than 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. More than 5,000 healthcare organizations worldwide rely on ECRI Institute’s expertise in patient safety improvement, risk and quality management, and healthcare processes, devices, procedures and drug technology.      

ISMP Logo The Institute for Safe Medication Practices (ISMP) is an independent, nonprofit organization dedicated solely to medication error prevention and safe medication use. ISMP provides recommendations for the safe use of medications to the healthcare community including healthcare professionals, government agencies, accrediting organizations, and consumers. ISMP’s efforts are built on a nonpunitive approach and systems-based solutions.      
 
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