A 65-year-old man with knee osteoarthritis is admitted to a busy hospital due to an elective left knee arthroplasty. The operating room is running behind schedule, and the patient's case is delayed by 2 hours. Because of the delay, the surgeon is assigned a new operating room, circulating nurse, and supporting surgical team. When verifying this patient's planned operation, which of the following practices is most recommended to promote patient safety?

Question

A 65-year-old man with knee osteoarthritis is admitted to a busy hospital due to an elective left knee arthroplasty.  The operating room is running behind schedule, and the patient's case is delayed by 2 hours.  Because of the delay, the surgeon is assigned a new operating room, circulating nurse, and supporting surgical team.  When verifying this patient's planned operation, which of the following practices is most recommended to promote patient safety?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d97d_3170_bc81_a5fcf30e058a_MD0003_00 In the operative setting, the risk of sentinel events (ie, serious errors causing patient death or irreversible harm) such as wrong-side surgery is increased by high task complexity, urgency (eg, schedule delays, high case volume), and use of interchangeable surgical teams. Prevention of sentinel events requires systems-based strategies that anticipate, detect, and correct error. Time-out and site verification procedures are critical safety practices that emphasize team communication and redundancy. These procedures involve the following: Preoperative verification of operative site and patient identity (using 2 identifiers) by at least 2 providers: This process should involve the patient (or surrogate). Site marking, in which the surgeon clearly marks each operative site with permanent marker: Nonoperative sites should not be marked because doing so may cause ambiguity (Choice E). Final time-out immediately prior to incision involving the entire team: This verifies surgical site, surgery side, and patient identity. (Choices A, B, and D) An additional time-out must be performed in the operating room immediately prior to the initial incision. The final time-out procedures should include the entire surgical team because all members share responsibility for monitoring for safety and discrepancies may be detected by any personnel (regardless of experience). The length of time-out procedures should not be limited because all concerns or questions from team members must be addressed before beginning the procedure. Educational objective: Patient safety in the operative setting can be promoted through time-out procedures, which apply teamwork and redundancy to confirm patient identity and operative site and side. Preoperative site and identity verification should involve the patient (or surrogate)s and be performed by at least 2 providers; an additional final time-out should be performed in the operating room immediately prior to incision and involve the entire surgical team.

A 65-Year-Old Man with Knee Osteoarthritis Is Admitted to a Busy