State programs emphasize the need for patient safety

Web sites and shared protocols improve efforts

Although the Joint Commission on the Accreditation of Healthcare Organizations has provided a standardized, national road map to improvement of patient safety with its national patient safety goals, two states have approached patient safety as a statewide initiative that requires collaboration and communication.

In Ohio, 12 health care-related organizations worked together to develop a protocol for surgical and procedure verification. "We believed that standardization of a protocol that could be used in different hospitals would improve patient safety because many of our surgeons have privileges at more than one hospital, and it was difficult to comply with protocols that differed in each place," says Deborah Percha, RN, MSN, director of surgery at Alliance Community hospital and a member of the Ohio Patient Safety Institute task force that developed the protocol.

"Even though all of the organizations agreed to the importance of a standard protocol, there were some issues that were challenges," Percha admits. These differences included who was the appropriate person to mark the site, with some organizations requiring physicians to mark the site and other organizations allowing nurses to mark the site. The actual protocol uses the wording physician/designee to allow each organization to follow the protocol in a manner that fits their normal practice, she adds.

In Wisconsin, patients can check out performances of hospitals in several safety categories, including surgical site identification and procedural verification at An independent, multidisciplinary body composed of insurers, employers, and health care providers guided the development of CheckPoint, which provides data submitted by hospitals on a voluntary basis and is coordinated by the Madison-based Wisconsin Hospital Association.

It’s important to provide patient safety information to give patients information about their health care choices, says Connie Geigle-Mietla, RN, nurse manager of surgery and peri-anesthesia at St. Joseph Regional Medical Center-Covenant in Milwaukee. She says she is proud of her hospital’s 95% compliance rate for site marking and 97% compliance for procedural verification. "The key to our success is the physician buy-in that we obtained prior to implementing our policy," Geigle-Mietla explains.

The proposed policy included several points at which site and procedure are verified and a time-out in the operating room. By taking the proposed policy to section and department meetings, the surgery staff were able to educate physicians as to the importance of the policy and assure them these extra steps would not delay procedures.

Acceptance of the policy is evident in the time-out process, Geigle-Mietla notes. "Although we have designated the circulating nurse as the staff member who will call a time-out prior to the incision, any person in the OR can call for a time-out," she says. She laughs and adds that it’s not unheard of for a physician to call for and time-out and say, "Let’s get it right."

[For more about surgical site verification, contact:

  • Connie Geigle-Mietla, RN, Nurse Manager of Surgery and Peri-Anesthesia, St. Joseph Regional Medical Center — Covenant, 5000 W. Chambers St., Milwaukee, WI 53210.
  • Deborah Percha, RN, MBA, Director of Surgery, Alliance Community Hospital, 1310 Desert St. N.E., Uniontown, OH 44685. Phone: (330) 829-4000. E-mail:]