A 35-year-old man is admitted to the hospital after sustaining multiple injuries in a motor vehicle accident. He undergoes surgery for an open fracture of the tibia and a spiral fracture of the humerus. The tibial repair is successful, but the surgeon operates on the wrong arm. Which of the following procedures would be most effective in preventing a similar error?

Question

A 35-year-old man is admitted to the hospital after sustaining multiple injuries in a motor vehicle accident.  He undergoes surgery for an open fracture of the tibia and a spiral fracture of the humerus.  The tibial repair is successful, but the surgeon operates on the wrong arm.  Which of the following procedures would be most effective in preventing a similar error?

Quizplus · Accepted Answer

According to The Joint Commission's sentinel event statistics, wrong-site surgery is the most frequently reported serious adverse event. Emergency operations, failure to mark the surgical site, poor communication, and surgeon fatigue are contributing factors. As in this case, multiple procedures on the same patient and multiple surgeons will also increase the risk of operating at the wrong site. Therefore, a preoperative verification process is important to decrease this risk. In addition to marking the operative site, independent verification of the patient, procedure, and site by 2 health care workers (eg, a nurse and physician) should be performed. The "dual identifiers" must perform the verification independently because 2 clinicians verifying identifiers together can result in replicating an error. The Joint Commission recommends use of a "surgical timeout" immediately prior to the procedure in order to conduct a final verification of the patient, procedure, and site. (Choice A) Although an awake and aware patient can participate in the verification process, this is not an adequate substitute for dual independent clinician identification. (Choice B) Having these 2 clinicians verify the site together is not optimal as it increases the risk that they will replicate the error. (Choices C and E) Two independent identifiers are preferred. Educational objective: Risk of wrong-site surgery can be reduced by requiring "dual identifiers" (usually a nurse and physician) to independently confirm that they have the correct patient, site, and procedure. Checks must be truly independent to ensure patient safety. __________ References: Using "near misses" analysis to prevent wrong-site surgery. (http://www.ncbi.nlm.nih.gov/pubmed/24033453)

A 35-Year-Old Man Is Admitted to the Hospital After Sustaining