"YES" Marks the Site

July 2004

Giving the wrong medication, injecting the wrong patient, or causing an allergic reaction are just a few examples of patient safety concerns in a hospital.  Most patients are familiar with some of the precautions hospitals take to reduce the chance of a mistake.  Placing an ID wristband on patients is a well known safety precaution to reduce the chance for error, but there are many others.

In 2004 patient safety has moved to near the top of issues hospitals are addressing with new policies to prevent harm to patients.  National Patient Safety Goals have been established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).  Union Hospital, and the other accredited hospitals in the United States are increasing their focus on patient safety and implementing new policies and procedures to further reduce the chance of an error.

?When people come to the hospital, they trust their doctor and hospital staff to provide excellent care,? says Michele Garber, RN, director of inpatient services at Union Hospital.  ?And part of our job is to ensure the safety of our patients and reduce the chance that a mistake or human error could cause them harm.?

Accurate patient identification is just one many safety practices that hospitals are addressing.  ?Inpatient wrist bands will have at least two identifiers, patient name and birth date for example, that will be matched to any service or treatment order they are going to receive,? Garber says.  Outpatients, most of whom do not receive a wristband, are asked for their name and a second identifier to be matched against the doctor?s order.

Wrong-site, wrong-patient, and wrong-procedure surgery has produced the most dramatic headlines over the years.  While such mistakes are rare, the potential harm to the patient has prompted hospitals to adopt procedures to further reduce the chance of a mistake.

Union Hospital has developed an extensive pre-op checklist process to ensure the correct patient is having surgery, that the proper procedure will be done, and the surgery will be done on the correct part of the body.

Dr. Tom Teater, an orthopedic surgeon,
initials the knee of a patient, confirming
the "YES" that  Nancy Evans, RN,
had already marked.

Debbie Smith, RN, director of outpatient and perioperative services, says the pre-op verification process involves the patient, nurse, and surgeon. 

?The pre-op checklist has to be completed and signed before the operation begins,? Smith says.  ?The checklist ensures that we have all the patient?s records, x-rays, and other documentation, and that we are absolutely sure of what we?re about to do before we start.?

The checklist requires the surgical nurse or surgeon to mark the surgical site after confirming the patient identity.  This is done before anesthesia while the patient is awake and can participate in the marking.  Smith says the surgical site will be marked with the word ?YES?.  Then as a double check, the surgeon will mark or initial the site, confirming it is correct. 

With "YES" marking the correct knee,
the surgeon confirms the site mark by
adding his initials using a sterile pen.
All markings are wiped off after surgery.

This site marking is done with a sterile non-toxic marker that is visible when the surgical site is prepped.  It can easily be washed off by the OR staff after the procedure.

While some consumer advocates urge patients to mark themselves prior to surgery, the U.S. Department of Veterans Affairs reports that only one-third of patients who do the marking do it properly.

Once in the operating room, the surgical team stops for a ?time out? to confirm the patient?s identify, the procedure to be done, the site of the surgery, and to ensure that all needed x-rays, records, and equipment are available.  Any person in the OR can stop the procedure before it starts if they have any doubt about the accuracy of anything on the checklist.

Accurate patient identification and eliminating wrong-site surgery are two examples of seven National Patient Safety Goals established by JCAHO.  Gerber says other goals are designed to improve communication among caregivers by requiring a ?read back? of a verbal order from a doctor and by prohibiting use of certain abbreviations and symbols that could be misunderstood or confusing.

Other safety goals focus on use of high-alert medications, use of infusion pumps, effectiveness of alarm systems, and reduction of healthcare-acquired infections.

John Lischak, director of quality improvement, says compliance with the National Patient Safety Goals is an important part of the hospital?s accreditation program.

?All accredited hospital are required to take stops to become compliant with the goals, then review their plans regularly to ensure they remain compliant,? Lischak says.

Garber believes that patients will appreciate the extra steps being taken to ensure their safety. 

?Our patients and their families deserve our very best efforts to reduce the chance that an error might jeopardize their safety, Garber says.?


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