Continuing the effort to eliminate what it calls an entirely preventable class of error, the Joint Commission on Accreditation of Healthcare Organizations has updated its frequently asked questions on how to avoid performing a procedure on the wrong body part, wrong person, or the wrong procedure on the right patient. JCAHO has urged a zero-tolerance policy toward this type of error and offered a new Universal Protocol to standardize pre-surgery procedures for verifying the correct patient, the correct procedure, and the correct surgical site.
The protocol focuses attention on marking the surgical site, involving the patient in the marking process, and taking a final "time out" in the operating room to double check information among all members of the surgical team.
This question was updated recently: For "right/left" cases, is it acceptable to mark the opposite site with a "NO" rather than marking the intended operative site? JCAHO responds with, "No, that is not acceptable. The protocol specifies marking the intended site of the procedure. Marking the nonoperative site instead of or in addition to the operative site is explicitly prohibited by the protocol unless necessary for some other aspect of care (such as to warn against using a particular extremity for venous access because of a prior surgical procedure)."
A new question also was added, asking whether it is necessary to mark the site for laparoscopic procedures. JCAHO says, "If the target site is for organs that are paired, site marking is required to indicate the intended side, even though the site of insertion of the instrument is in the midline."
In response to a question about what type of marker is appropriate, JCAHO advises using a marker that is "sufficiently permanent to remain visible and will not wash off when the site is prepped" and cites commonly available surgical markers or pens as an example.
JCAHO also addresses whether a separate form is needed to document that the site was marked, saying the protocol does not specify the type of documentation. However, JCAHO points out that the Universal Protocol does require you to document, in some way, these elements:
- Correct patient identity
- Correct side and site
- Agreement on the procedure to be done
- Correct patient position
- Availability of implants
- Availability of special equipment or special requirements.