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Radiology Daily
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Preoperative “Time Out” May Prevent Intraoperative Deaths

March 6, 2008
Written by: , Filed in: Practice Management
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A major surgical ‘never events’ item is the intraoperative or immediate
postoperative death in ASA Class 1 patients, who represent patients with the
least amount of surgical risk and are the easiest to care for in the operating
room.

Most preventable medical errors do not result from individual recklessness.
Nonetheless, a list of serious preventable ‘never events’ has been developed
that includes a series of errors associated with the surgical care of
inpatients and outpatients. A major item on this list of surgical ‘never
events’ is the intraoperative or immediately postoperative death in an
American Society for Anesthesiologists (ASA) Class 1 patient.

The ASA classifies surgical patient risk based on their presenting history.
ASA Class 1 patients present to the hospital or clinic for a minor surgical
procedure. They have no chronic conditions, no issues with their airway, and
no other identified conditions. These ASA Class 1 patients represent the least
amount of risk and are the easiest patients to care for in the operating room.

However, on rare occasions, an intraoperative or immediately postoperative
death will occur for an ASA Class 1 patient, which is considered a ‘never
event.’ To prevent such deaths, the surgical team must know the patient’s
history and possible risks during various portions of the intended procedure.

To help prevent surgical ‘never events’ like this, the Joint Commission on
Accreditation of Healthcare Organizations published the Universal Protocol for
Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery. The
Pennsylvania Patient Safety Authority organized the Universal Protocol into
three different phases.

In phase one, the preoperative verification process, all the different
documents and studies are reviewed, and preparations are made for the
procedure.

In phase two, the protocol describes the proper marking of the operative site
and who is responsible for this task. An “X” is not used to mark the operative
site because it is ambiguous. Instead, initials are preferred (or the word
“yes” can be used) for marking the site with an indelible marker.

In phase three, a “time out” is taken before starting the procedure so that
the anesthesia team, surgeon, physician, and nursing staff can review the
paperwork, evaluate the process, and verify that the patient, the equipment,
and the operative site are all correct.

If this verification process is delayed until after the procedure, then
someone on the team is not going to remember some item. Do not rely on a
checklist. This step cannot be done by rote or by saying, “We’re here for this
specific procedure. Yeah, okay, let’s get going.” This final step must be
taken seriously and performed appropriately.

By following the Universal Protocol, fewer intraoperative or postoperative
deaths should occur. Physicians, surgeons, and surgical staff members should
take all possible precautions to prevent these deaths, both before and during
the procedure.

Reference:
Kathleen Hale, RN, BSN, MHSA, and Richard P. Kidwell, JD Never Events:
Intraoperative or Immediately Postoperative Death in Normal Healthy Patients.

A major surgical 'never events' item is the intraoperative or immediate postoperative death in ASA Class 1 patients, who represent patients with the least amount of surgical risk and are the easiest to care for in the operating room. Most preventable medical errors do not result from individual recklessness. Nonetheless, a list of serious preventable 'never events' has been developed that includes a series of errors associated with the surgical care of inpatients and outpatients. A major item on this list of surgical 'never events' is the intraoperative or immediately postoperative death in an American Society for Anesthesiologists (ASA) Class 1 patient. The ASA classifies surgical patient risk based on their presenting history. ASA Class 1 patients present to the hospital or clinic for a minor surgical procedure. They have no chronic conditions, no issues with their airway, and no other identified conditions. These ASA Class 1 patients represent the least amount of risk and are the easiest patients to care for in the operating room. However, on rare occasions, an intraoperative or immediately postoperative death will occur for an ASA Class 1 patient, which is considered a 'never event.' To prevent such deaths, the surgical team must know the patient's history and possible risks during various portions of the intended procedure. To help prevent surgical 'never events' like this, the Joint Commission on Accreditation of Healthcare Organizations published the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery. The Pennsylvania Patient Safety Authority organized the Universal Protocol into three different phases. In phase one, the preoperative verification process, all the different documents and studies are reviewed, and preparations are made for the procedure. In phase two, the protocol describes the proper marking of the operative site and who is responsible for this task. An "X" is not used to mark the operative site because it is ambiguous. Instead, initials are preferred (or the word "yes" can be used) for marking the site with an indelible marker. In phase three, a "time out" is taken before starting the procedure so that the anesthesia team, surgeon, physician, and nursing staff can review the paperwork, evaluate the process, and verify that the patient, the equipment, and the operative site are all correct. If this verification process is delayed until after the procedure, then someone on the team is not going to remember some item. Do not rely on a checklist. This step cannot be done by rote or by saying, "We're here for this specific procedure. Yeah, okay, let's get going." This final step must be taken seriously and performed appropriately. By following the Universal Protocol, fewer intraoperative or postoperative deaths should occur. Physicians, surgeons, and surgical staff members should take all possible precautions to prevent these deaths, both before and during the procedure. Reference: Kathleen Hale, RN, BSN, MHSA, and Richard P. Kidwell, JD Never Events: Intraoperative or Immediately Postoperative Death in Normal Healthy Patients. [text_ad]
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