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Wrong-site surgery preventable with precautions
LONDON — Wrong-site surgery can be prevented if appropriate procedures are used for verification, said Adeel Shaikh, MD, of the Royal Eye Infirmary in Plymouth, England.
"Our hospital protocol, implemented in 2001, has resulted in elimination of wrong-site surgery in spite of high-volume activity," he told attendees at the United Kingdom and Ireland Society of Cataract and Refractive Surgeons meeting, held here in conjunction with the European Society of Cataract and Refractive Surgeons meeting.
The protocol used at the hospital requires that the consent form, operating notes and doctor's order for preoperative medications must all be available in the operating room. The protocol also requires that the skin be marked next to the eye undergoing surgery and that the patient must confirm which eye is to be treated immediately before the procedure.
Before every procedural stage (administration of eye drops or medications, anesthetic injection, sedation and incision), the nurses, anesthesiologists and surgeons also double-check the consent, case notes, skin mark and patient's answer, establishing that they all match. If there is any discrepancy, the surgeon makes the final decision, and the discrepancy is corrected and reported.
"During the 5-year period between 2001 and 2005, there were approximately 17,000 eye procedures performed in our hospital, the majority of which were under local anesthesia," Dr. Shaikh said. "Two near-miss incidents were reported, one of a wrong procedure on the operating list as compared to the patient's case notes and the other of the wrong side. Both were identified by the nursing staff ... prior to the patient being transferred to the operating theater. A third case was an incidental instillation of preoperative eye drops in the other eye. No claim arose from the cases reported."
Dr. Shaikh recommended developing and using similar protocols in all surgical practices and advocated a prospective national survey to assess the extent of the problem.