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October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
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A771
October 19, 2008 2:00 PM - 4:00 PM Room Hall E2-Area N, |
| Universal Protocol: Mark All, Miss None |
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Krista Curell, J.D., R.N., Thomas Cutter, M.D., M.A.Ed Department of Patient Safety, University of Chicago Medical Center, Chicago, Illinois |
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Introduction: Prior practice was that the surgeon must mark the surgical site and then record this when the surgery involved digits, vertebral level or right/left distinction, including midline insertion or incision sites. Review of records revealed that documentation was sporadic, which yielded the additional concern that site-marking might be as well. An educational intervention was instituted to better ensure both site-marking and its documentation. Methods: A new protocol was implemented, requiring all surgical sites be marked with the initials of the attending surgeon or his/her resident, PA or APN designee. In the event the patient refused to have his/her surgical site marked, the refusal was documented in the medical record. If the site did not lend itself to initialing, (e.g., genitalia, perineum, anus, tonsils, burns), then a blue band was initialed and placed on the wrist or ankle by the physician, PA, or APN. Record of site marking was documented by the OR Nurse. Data was collected by trained nurse auditors before and after the educational intervention. Results: Over 600 charts were audited. Auditors recorded if the surgical site marking was visible prior to incision and that the nurse had documented that the surgical site was marked. Figure 1 shows the results of the audits.[figure1]Site marking has been sustained with a perfect record for 12 weeks. The nurse documentation has also improved but at a lesser rate than the surgeons compliance with the actual site marking. Discussion: The rationale for marking all was out of a concern that the surgeons who had a mixed practice of both midline and lateral/level procedures were not in the habit of marking any. Midline procedures with right/left distinction were also considered a potential problem. By establishing the protocol of marking all, it was predicted that surgeons were less likely to neglect the process. Although our success may just be a result of the Hawthorne effect, it can also be argued that over 24 weeks the auditors faded into the backround, thus eliminating or at least minimizing this influence. The fact that the nurses and the surgeons were subject to the same scrutiny and that the nurses lagged behind also argues against the Hawthorne effect as a principle driver of the change. Thus, it appears that marking all sites improved compliance once it was required for all procedures as a routine practice. Continued but less frequent, open and predictable auditing will better demonstrate if the mark-all strategy is effective or if the reminders and frequent audits were the predominant drivers. Anesthesiology 2008; 109 A771 |
Figure 1
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