Patient Safety/Risk Management Tips

Orthopedic Surgeons

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Use the Universal Protocol designed to prevent wrong patient/side/site surgeries.

Follow the facility’s protocol for marking the surgical site appropriately (initials or “yes”) with the patient’s (or representative’s) input prior to surgery, and complete a verification as part of the time out. Wrong side/site surgeries account for 9 percent* of orthopedic incidents, and they are on the list of events designated by the National Quality Forum that should “never happen.” Statistics are that one in four orthopedic surgeons will have such a case in a typical career.

Complete instrumentation/device checks prior to surgery.

Use the time out to assure that needed radiologic films are present and that necessary instruments are present and in working order. It is also the time to see that any implantable devices are available, working properly, and appropriately matched as to size and side. Instrumentation or device problems are an issue in 30 percent* of orthopedic incidents.

Embrace patient safety hand off and communication tools.

Communication is an issue in 26 percent* of orthopedic incidents, and each of these tools is designed to encourage good communication in order to avoid patient injury: Briefing is a way to be sure that everyone is “in the same movie” and properly focused so there should be no surprises. Debriefing is a way to examine what could have been done better and what went well. The “Time Out” is a mandated (Joint Commission) last chance break before making an incision, a last opportunity to assure that the correct surgery on the correct patient is about to be done on the correct side, site, and level and that all of the requisite people, instruments, and devices are present and in proper working order. “Speak Up” is a communication tool to encourage team members to speak up if they feel unsure or that something is not right. “SBAR” (Situation Background Assessment Recommendation) is a communication format designed to get to the heart of an issue quickly when communicating about patients.

Prevent deep venous thrombosis in hip and knee replacement surgeries.

Follow the AAOS Clinical Guideline on Prevention of Symptomatic Pulmonary Embolism in Patients Undergoing Total Hip or Knee Arthroplasty. This includes a preanesthesia assessment of risk and a discussion with the anesthesiologist as to the consideration of regional anesthesia.

Follow safe medication practices.

Use only approved abbreviations, keep a current medication list in each patient record, do not leave prescription pads in exam rooms, and document when samples are given. Know the contraindications of the medications prescribed and the possible interactions with other medications. When writing a prescription, include the name of the medication, the route, the dose and frequency, and the indication or reason for the prescription (for pain, inflammation, sleep, muscle relaxation, etc.). Not only does this help the pharmacist in the case of look-alike, sound-alike situations, but it also helps the patient recall the purpose of the medication and whether or not it is helping.

*AAOS member patient safety survey: www2.aaos.org/aaos/archives/bulletin/aug06/fline11.asp