By Stephen W. Earnhart, MS
Earnhart & Associates
There always is a lot of reaction to my Q&A articles. The following are actual questions that were asked in the past month or so related to patient safety, liability, and compliance. I hope this column answers some questions that you have.
Question: Our surgeon insists that his private scrub tech mark the surgical spot on the patient in preop. I admit that he does initial her site when the patient is in the room, but the rest of us in the OR feel that he really is just parroting what she already has marked and not paying attention to what might or might not be the correct site. We (members of the OR staff) have been told by our supervisor that he is following protocol. What do you think?
Answer: I agree with you. You can have as many people as you want mark the operative site, but the only one that matters is the one the surgeon marks and initials. The surgeon needs to mark the operative site in preop and not in the operating room, where it is unlikely that the patients are engaged in the process of verification with all the distractions and likelihood that they have had some sedation. Now, is what the surgeon and his private scrub are doing wrong? Technically, no. But the surgeon might have a difficult time explaining to the patient, the family, and a jury why he chose to do it the way he did when everyone else does it the “right” way.
Question: Our hospital surgical timeouts have gotten sloppy. What is the best way to do them?
Answer: Each facility does it differently, I suppose, and certainly many have become lax in how they carry out this important step in patient safety. I have observed timeouts while the patient is being wheeled down the surgical corridor. For a timeout to be effective and accurate, everyone in the room needs to be engaged in the process. Anesthesia cannot be fiddling with the monitor. The circulator cannot be grabbing a pack from the shelf. The surgeon cannot be adjusting a gown or engaged in other activity. To be effective, everyone and all activity and conversations in the room need to cease completely. Have a hard time getting everyone’s attention? Blow a whistle!
Question: What is the best way to verify a patient in the holding area?
Answer: Ask them their names and dates of birth. Those are two easy questions that most patients know.
Question: I work in a new freestanding surgery center that some of our surgeons built. The administrator for the center is a woman who has no experience in running the center and is not a registered nurse. I checked the regulations for the state and Medicare that say the facility must be run by a registered nurse. Who can I report this group of surgeons to for not following state and federal regulations?
Answer: Before you go and embarrass yourself, you need to understand the actual regulations a bit more. Your state and Medicare require that there be an RN overseeing the clinical activities in the facility and that there must be an RN in the rooms for all procedures when the patients have been sedated or are in the facility. There is no regulation that says the administrator of the facility must be an RN. Now, that being said, many freestanding surgery centers DO have an RN as the administrator. The “whys” are that it not only satisfies those two regulations, but for most, the feeling is that they are the most well-rounded to handle issues as they arise in a surgery center. [Earnhart & Associates is a consulting firm specializing in outpatient surgery development and management. Contact Earnhart & Associates, Austin, TX . Phone: (512) 297-7575. Fax: (512) 233-2979. E-mail: firstname.lastname@example.org. Web: www.earnhart.com.]