Confirm correct site, then apply your John Hancock
Confirm correct site, then apply your John Hancock
Here is how the American Academy of Orthopaedic Surgeons (AAOS) recommends signing patients to avoid wrong-site surgery:
• The surgeon should be responsible for checking all records, films, and other indicators of the proper surgery site. It is not enough to have an assistant confirm the site. The whole idea is to make the surgeon personally responsible for the crucial site check.
• Ask the patient to indicate the correct site.
• Use a permanent surgical pen. The pen can be sterile or unsterile, of the type commonly used to mark patients’ skin for surgery. The marks typically last five to seven days and are thought to have no effect on the infection rate.
• The surgeon should sign his or her name directly on the operative site. Variations abound, such as using initials or writing "no" or "not this leg" on the other limb. Those are not as good as signing the correct site. The other limb will not be visible when the patient is draped, so the surgical team cannot be sure what is on the other limb. It is better to sign directly on the surgical site, so the surgeon has no doubt where to operate. The AAOS recommends initials, but some say a complete signature is more easily recognized by the surgeon and others, whereas initials could be confused. An "X" is never a good idea. Does an "X" signify "X marks the spot," or "not here"?
• The surgeon should not proceed unless the signature is visible. This is another reason to sign directly on the surgical site, not just nearby. Never assume the signature is under the drapes.
• Encourage the rest of the surgical team to confirm the signature site. Any member of the surgical team should feel comfortable questioning why there is no signature visible at the site about to be cut.
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