A universal and more exact set of protocols for avoiding wrong-site surgery goes into effect July 1 at hospitals, replacing a previous set of requirements that forced providers to confront the issue but left enough room for interpretation to introduce confusion and the risk of mistakes.
The Joint Commission on Accreditation of Healthcare Organizations will make the protocols a formal part of the accreditation process. Endorsed by more than 40 healthcare associations and medical societies nationwide, the universal protocols are "more prescriptive" than the JCAHO's first try at elevating the issue to a safety priority, said commission spokesman Mark Forstneger.
Two years ago, the JCAHO included requirements for avoiding surgical mix-ups in its first set of six National Patient Safety Goals, which accredited organizations must prove they follow as part of the information they supply about their clinical performance. The objectives: to prevent the wrong procedure from being performed on a patient and to avoid surgery done on the wrong patient or the wrong part of the body.
The safety requirements included a preoperative verification of both the procedure details and the patient undergoing the operation as well as a timeout for a final check and a standard way of marking the surgical site. But standard procedures could vary from one hospital to another. For example, a mark could signify where to operate or where not to.
The new protocols specify that the only places to be marked are the operative sites and that the site should be marked by the person doing the procedure. Adhesive markers should not be the sole means of identifying the site. Also, the timeout must be documented.
The surgery safety precautions will be removed from the separate list of patient-safety goals, and the universal protocols will be included in the scoring process during on-site accreditation surveys, Forstneger said.