Marking Patients and Safe Surgery Steps, Research Paper Example

The following paper focuses on the broad subject of preparing patients for surgery, with a particular focus on marking surgical sites and other safety measures and protocols. It is intended to offer insight into the general subject of patient preparation while also contextualizing the information provided in terms of the (Name of Surgery Center).  The paper is structured to offer useful and applicable background information about patient preparation along with a fisrt-person account of the protocols used at (Name of Surgery Center). The perspective of the author is that some of the safety protocols in place at (______) could be improved, and that such improvements would lead to a safer surgical environment for patients and also support positive post-surgery outcomes. This information should not be taken as an argument that (________) is an unsafe facility; there is no question that the entire staff of surgeons, surgical assistants, anesthesiologists, and everyone else at (___) operate according to safe and well-regarded safety guidelines. Given the importance of ensuring patient safety, however, it is appropriate to consider any and all ways that surgical preparation protocols could be improved.

Background and Overview

Despite what some headlines in the news may claim, the health care system in the United States is among the very best in the world. The U.S. is one of the leading nations in research and development, and the pioneering of new medical and surgical techniques and practices. Moreover, the U.S. is home to some of the finest educational institutions in the world. While there is no doubt that there are areas in which improvements could be made, it must also be acknowledged that millions of Americans have access to high quality health care. It should also be noted that with the implementation of the Affordable Care Act (ACA) millions of previously-uninsured Americans are now able to access affordable health care through state-run exchanges, expansions of Medicare and Medicaid, and the federal health care exchange system.

Because of the changes brought about by the ACA and other developments in the overall system of health care in the U.S., there has been a paradigm shift in the way that health care providers are interacting with patients. The old model of reimbursement from federal programs like Medicaid was built around payments for procedures. This was intended to ensure that health care providers offered patients whatever appropriate tests and treatments were available; at the same time, this model placed some notable restrictions on which tests and treatments were approved and the rate at which they would be reimbursed. With the advent of the ACA, there has been a shift towards “patient-centered” care; in this model, payments and reimbursements are being closely tied to two factors: patient outcomes and patient satisfaction (Malloy et al, 2013). The purpose of these changes is to incentivize health care providers to engage patients in the process of managing their own health, both by providing all necessary information needed for patients to make informed decisions and by working with patients to avoid using costly and unnecessary tests, treatments or procedures that are not geared towards ensuring positive outcomes.

As a result of these and other changes, health care facilities and organizations are working to make processes faster, more streamlined, more efficient, and more effective. As more patients enter the health care system under the ACA, it is more important than ever that efficient care be balanced with effective care. Nowhere is this more vital than in surgery centers, where a combination of new patients entering the marketplace of health care coupled with an aging population is making many surgery centers more crowded than ever. These changes make it imperative that all process and procedures related to preparing patients for surgery are safe and effective, as there is rarely any margin for error when a patient is going on the operating table. Among the most important protocols involved in preparing patients for surgery is the need to mark the surgical site to ensure that procedures are done correctly (Liddle, 2011). There have been some horror stories in the media about patients who had body parts amputated or procedures performed on the wrong organs; marking surgical sites correctly is a key step in ensuring that such accidents remain as rare as possible.

Marking the Surgical Site and Safe Surgery Steps

There are a number of standard steps involved in the safety protocols at (______). Among the first is to interact with the patient to help alleviate anxiety, and to go over the procedures that will be performed to ensure that the patient fully understand what he or she is going to experience both during and after the surgery. There are other steps as well, but among the most important is the need for everyone involved in the surgery to identify the patient. Harder (2014) describes the safe surgery process steps used at many hospitals and surgery centers; a similar system is in place at (____). This process involves several stages during which the patient is identified and the surgical area is marked. The first step takes place before the patient is taken to the OR, where caregivers properly identify the patient and verify the scheduled procedure. In most cases the surgical site should be marked appropriately at this stage of the process (Harder, 2014).  The intervention suggested for implementation at (_____) is what is described by Harder as the Minnesota Hard Stop; this name is applied simply because the author is an associate of the Minnesota State Hospital system. It need not be identified as such when used in other facilities.

The hard stop means exactly what it sounds like: everyone involved in the process stops what they are doing to perform a final check before transporting the patient to the OR. It is not always established protocol in all surgery centers that such a hard stop be performed. By doing so, the possibility that a crucial player in the process may not be aware of a problem is avoided. The hard stop does not need to take long; it is simply an opportunity for everyone to check their information against the information others have. This redundancy may seem simple, but there is no question t at it can help avoid serious problems in the OR. Once the patient has arrived in the OR the team should have a briefing conducted by the lead surgeon or other appropriate team member. This provides yet another opportunity to ensure that everyone understands what they will be expected to do, that the patient has been properly identified, and that the surgical site has been marked when appropriate and necessary. After the briefing has concluded, the operating team should perform a second hard stop to provide one final opportunity to check everything before the first incision.

The process of marking the site is known as a “microprocess” (Maloy et al, 2013); it is a smaller process that is part of the larger process of surgical preparation, and it has its own steps and protocols. The individual responsible for marking the surgical site –typically the surgeon- first checks the patient’s order, the patient’s consent form, and checks with the patient to verify the procedure (Harder, 2014). In the era of patient-centered care, a well-informed patient will be up to speed on what procedure he or she is about to undergo; if this is not the case, the surgeon or other team member has a final opportunity to provide all necessary information to the patient or patient representative. Any discrepancies that may arise should be dealt with prior to the surgeon or other team member marking the surgical site.

The surgeon or other team member responsible for marking the site will use an indelible marker to clearly identify the surgical site. There are some instances where this is not possible; for example, teeth cannot be marked (Harder, 2014). In most instances, however, it is possible to mar the area of the surgical site and to identify where incisions will begin. It is also necessary to ensure that pens used for marking surgical sites are only used one time. Studies have indicated that even after a patient has been disinfected for surgery, a pen that has been used on a previously-disinfected patient can carry a significant risk of nosocomial (hospital-acquired) infection (Ballal et al, 2007). Other types of pens have been tested to determine whether they are likely to support bacterial growth, and dry white markers (which are easier to clean off skin post-surgery) have been seen to support higher rates of bacterial growth than permanent markers. The outcomes of such research studies make it clear that pens used for marking surgical sites must only be used once, and for safety and health reasons should be discarded along with other potentially biohazardous material immediately after use to ensure that they are only used once.

Safety Procedures and Surgical Site Marking at (____)As noted previously, the safety protocols in place at (___) are generally considered to be safe, and the staff and surgical team members are all highly-trained and efficient at their various tasks. The facility has an outstanding safety record, and as a team member there I am proud to say that I am a part of that track record of safety. Having said that, my research into the issue of surgical site marking has led me to believe that there are some ways that safety and procedural protocols could be improved in order to ensure that surgical sites are always marked correctly and that other safety steps are always followed correctly. The standard of practice at (____) does include many of the safety steps described in the previous sections, though there are fewer redundancies, especially related to the matter of performing hard stops and double- and triple-checking to ensure that surgical sites are correctly marked

The safety protocols at (___) do call for a hard stop before the surgeon makes the first incision. During this hard stop, every team member in the room must stop whatever he or she is doing; if one or more team members are in the middle of performing a task, the hard stop is delayed until they complete what they are doing. Once everyone is able to stop, the surgeon takes a quick time out to ensure that everything has been properly checked, that the patient has been identified, and that the surgical site has been properly marked. This is, however, the only time that a hard stop is performed, and it is my recommendation that a hard stop be added to the pre-surgery processes. Such a hard stop would allow greater opportunities for the prep team to ensure that the marking was done properly, so that by the time the patient made it to the OR the hard stop and site check would be redundant to the first one.

From a practical standpoint it should not be overly difficult to implement new procedures and protocols that added a hard stop during surgery preparation. There are checklists for every stage of the process from the time the patient arrives at the surgery center until he or she leaves. The surgery preparation checklist could be modified to include a hard stop just before the patient is taken to the OR. If the surgeon has already marked the site (which is usually the case) then adding a hard stop should only take a few seconds to a minute to go over everything on the checklist one more time.

Barriers to Implementation

Despite the fact that it seems like a relatively simple matter to add a second hard stop to the preparation protocols, there are a number of potential barriers to that could potentially arise. The first of these would simply be convincing the management and staff that it is necessary to do so; in an environment where the systems and processes have been in place for a long time, it may be difficult to convince anyone that change is necessary. The next barrier would be in actually getting the team members to perform the hard stop. In the current set of protocols, there are some team members who are constantly busy dealing with various tasks, and trying to get everyone to be able to stop all at the same time would likely be at least somewhat disruptive to many of them. A hard stop really does mean that everyone must stop, and this would take some time for everyone to modify their routines in order to ensure that they could all stop at the same time, even if it is just for a minute.  The third, and most significantbarrier is that the idea of implementing a second hard stop might be seen as too much of a waste of valuable time in a fast-paced environment. If the potential value of adding a second hard stop is not perceived as outweighing any considerations about lost time, then it will likely not be implemented.

The value of doing two hard stops may be difficult to prove in this particular environment. Even evidence gather in research studies may only be specific to the sites where the studies were performed. Despite possible concerns about the amount of time it would take up to add a second hard stop, the safety of every patient is potentially at stake. In a time where surgery centers are getting busier and treating more and more patients, taking a few extra seconds to do a safety check might be the best possible decision.

References

Ballal, M., Shah, N., Ballal, M., O’Donoghue, M., & Pegg, D. (2007). The risk of cross-infection when marking surgical patients prior to surgery–review of two types of marking pens. Annals Of The Royal College Of Surgeons Of England, 89(3), 226.

Harder, K. (2014). Safe Surgery Process Steps (including the Minnesota Time Out) to Prevent Wrong Surgery. http://www.health.state.mn.us/. Retrieved 16 September 2014, from http://www.health.state.mn.us/patientsafety/publications/safesurgery.pdf

Leckrone, R. (1991). Preparing Your Patient For Surgery. Nursing2013, 21(7), 46–49.

Liddle, C. (2011). Preparing patients to undergo surgery. Nursing Times, 108(48), 12–13.

Malloy, C., Little, B. and Michael, M. (2013). Improving Wait Times in Primary Care Using the Dartmouth Microsystem Improvement Curriculum. Journal of nursing care quality, 28(3), pp.250–256.