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Marking surgical sites keeps worst case scenario from ever happening at NUMCThe worst case scenario of wrong site surgery rarely happens in any hospital and has never happened at the New Ulm Medical Center. Yet, hospitals all across the country, including New Ulm Medical Center, have put into place processes to make sure it doesn’t happen. It starts with marking the surgical site shortly after the patient arrives for surgery. “For example, if a patient is coming in for a right total knee replacement, they will arrive in the surgery department and actually write ‘YES’ in indelible ink on the correct knee,” said Janet Filzen, RN, Surgical Services Manager. There are some types of surgery for which marking is not required, like anything that doesn’t have a paired organ. But, carpel tunnel, knees, ovaries, cataracts, and toes are all examples of those that are marked. “If it is obvious, such as if the patient has a cast, we don’t mark that,” Filzen said. If a surgeon is going to be stripping varicose veins, he or she will actually mark the affected veins. “In some cases it isn’t a matter of marking right or left, but marking the actual site, such as in a breast biopsy,” Filzen said. For podiatrist Steve Wachter, DPM, it is not uncommon to have to mark more than one toe for a hammer toe surgery. “The site marking is just a good opportunity to review with the patient what you are about to do and which toe you are doing,” Wachter said. Other sites that Wachter may mark include bunions or heels. Patients seem to have varying responses to the surgical site marking, said Wachter. “Some are really paying attention and have marked the site themselves with a big arrow.” Filzen has also seen the full gambit of reactions. “We have some patients who come in with a big ‘X’ that says ‘NO.’ They are worried about a wrong site surgery – they often have read about a case in the newspaper,” Filzen said. “Some are relieved that you are marking the site. Some think it’s unnecessary.” The indelible ink comes off with an alcohol based solution, but it doesn’t come off with the preparatory solution used before surgery. “It is a constant visual reminder of the site you are about to operate on,” said Filzen. Site marking is really a collaborative effort between the staff, the patient and physician, Filzen said. “Any time there is a discrepancy, everything is stopped and the surgeon is called in to have a conversation with the patient or family member to verify what we are doing. We are always asking ‘Is this what you and your physician agreed upon – is this what you talked about?’” said Filzen. The verification continues into the operating room where the circulating nurse performs a final “time out.” Everyone in the room stops and the nurse states the patient’s name, the procedure that is about to take place and verifies that the necessary equipment and x-rays, etc, are all present before the surgery begins. Most of the time, the patient has already been sedated when the “time out” is performed, Filzen said. “We make sure it is all in place long before this, so we know that on the day of surgery we will have everything we need to do that surgery,” Filzen said. “The “time out” is just the last and final verification that we have everything.” Surgical site marking and taking a “time out” may seem like a trivial extra step to some. “The cases of wrong site surgery are pretty rare,” Wachter said. “But, if it happens to you, who cares what the statistics say. This is our final verification to ensure it doesn’t ever happen.”  Back to Health Edition |
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New Ulm Medical Center
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