Correct Patient, Procedure, Site - Knee Replacement
At Highland Hospital, the following steps are taken to ensure correct-patient, correct-procedure, and correct-site.
Pre-admission collection and review of medical records
Pre-operative verification checklist used (includes multiple clinical check points, such as laboratory test results and armband check)
Marking of site intended for surgical repair
Operative team review of procedure details with built-in pause (time-out)
Wrong-patient, wrong-procedure, or wrong-site knee replacement surgeries are common, but they can be avoided altogether by following careful procedures prior to surgery. The following procedures cover broad areas of concern in preventing surgical mishaps; however, there are additional safeguards used by surgical teams that are not listed here.
The first procedure involves review of relevant medical records prior to surgery. These records may contain information that will prevent the need for additional tests, saving time and money. They may also provide vital facts about your health history that your surgical team needs to know.
Secondly, according to the Joint Commission's Universal Protocol for Prevention of Wrong Site, Wrong Procedure, Wrong Person Surgery, it is recommended that the operating surgeon mark the operative site using a signature or other approved mark.
Extra care should be taken with moist areas that can smear onto another site such as the inside of the thigh, according to a report in Anesthesia and Analgesia (January, 2005; 100 (1): 300). Smearing can occur where marked skin touches unmarked skin and the unintended marks may cause confusion about the correct site for surgery.
Lastly, just prior to surgery a final review is performed to ensure that the right patient is having the right procedure on the right body part, with all necessary patient information available. The armband may be checked several times during this process to verify that the team has the correct patient.
An opportunity for speaking up is provided during this final review; it is a built-in pause (time-out) to provide an opportunity for anyone on the surgical team to speak up about anything related to the procedure or patient that is questionable.