Prince of Wales Hospital

Transcription

1 Prince of Wales Hospital Department of Surgery 123 Surgical Safety 123 Correct Site Marking : Policy Nov

2 Content : 1. Purpose of this Policy 2. Principles 3. Standards to be followed 4. Failure to follow policy 5. Circumstances where marking may not be appropriate 6. References 7. Appendix 1 Alternative Marking Sheet 2

3 1. Purpose of this Policy Pre-operative marking has a significant role in promoting correct site surgery, including operating on the correct side of the patient and/or the correct anatomical location or level. This Policy is to provide appropriate guidance to all surgeons on the management of correct site/side surgery. 2. Principles Wrong site, wrong procedure, wrong patient surgery can & MUST be prevented A robust, universal and comprehensive approach by using complementary strategies is required to achieve the objective Active involvement & effective communication among all members of the clinical teams (nurses and surgeons) is important for success Consistent implementation of a standardized approach A requirement for site marking should focus on cases involving RIGHT/LEFT distinction, and or multiple structures (fingers, toes). Procedures requiring marking are decided and agreed by teams and the departments which this policy is applied. This policy should be applicable or adaptable to all operative invasive procedures that expose patients to potential harm, including procedures done in settings other than the operating room. 3

4 3. Standards to be followed 3.1 Pre-operative marking The purpose is to mark unambiguously the intended site of incision/insertion 3.2 How to mark An indelible marker pen should be used. The mark should be an ARROW that extends to, or near to, the incision site which should remain visible even after the application of skin preparation. It is desirable that the mark should also remain visible after draping. 3.3 Where/What to mark Surgical operations involving side (laterality) should be marked at or near, the intended incision. For digits on the hand or foot the mark should extend to correct specific digit. An arrow on the side of the procedure extend to or near to the incision site should be used. If the operative procedure involves specific (e.g. skin) lesion, it must be marked It is acknowledged that under certain circumstances the surgical intervention may be modified according to the clinical finding in the course of the actual surgical procedure. This needs to be made clear to the patient as part of the consenting process and information discussion. Multiple operation sites must be individually marked. 3.4 Who marks Marking should be undertaken by the operating surgeon, or nominated deputy, who will be present in the operating room at the time of the patient s procedure. 3.5 Involvement of others The process of pre-operative marking of the intended site should involve the patient wherever possible. In case of children, parents should be involved in the process of marking. In case of incapacitated/vulnerable adults, family members should be given the opportunity to be involved in the process of marking. 3.6 Time & Place The surgical site should be marked in the surgical ward or Day-surgery ward prior to patient transfer to the operating theatre. Marking should take place before pre-medication. 4

5 4. Failure to follow Policy 4.1 If failure of pre-operative marking occurs, the surgeon in-charge should be contacted, assess the situation and either: (a) Follow the Policy for marking the correct site using the supporting information to verify the marking and document the decision in medical note (b) Return the patient to ward / Day-Surgery centre 5. Circumstances where marking may not be appropriate 5.1 Procedures requiring marking are decided and agreed by teams and the departments which this policy is applied. 5.2 Dire-emergancy surgery should not be delayed due to lack of pre-operative marking. 5.3 Cases of bilateral simultaneous organ surgery such as bilateral squint surgery 5.4 Situation where the laterality of surgery needs to be confirmed following examination under anaesthesia or exploration in theatre. 5.5 Teeth,mucous membranes and perineum. 5.6 For neonates/premature infants, which marking may cause a permanent tattoo. 5.7 Patients refuse pre-operative skin marking, then Alternative Marking Diagram should be used. 5

6 6. References NPSA Patient Safety Alert 06 2 March 2005 The Joint Commisssion on Accreditation of Healthcare Organisations. Critical Access Hospital Accreditation Program Chapter: National Patient Safety Goals. Correct Site Marking: Policy. Southampton University NHS Trust. May 2007 Royal Australasian College of Surgeons Implementation Guideline for Ensuring Correct Pateint, Correct Side and Correct Site Surgery. Sept

7 Appendix 3 - Alternative Marking Sheet Right Front Left Left Back Right Right Front Left Left Back Right 7

8 General Surgery 1. Inguinal & femoral hérnia repair (open or laparoscopic) 2. Thyroid Surgery (Hemithyroidectomy) Parathyroid surgery Incisional / excisional biopsy of lymph nodes at groin / supraclavicular fossa / cervical region 3. Procedure for varicose vein of legs Lumps & bumps excision over the torso or limbs 4. Adrenalectomy / Adrenal surgery General Surgery 5. Incision and drainage for buttock (deep-seated ischiorectal fossa) abscess (Colectomy / proctectomy for cancer does not require site marking) 8

9 Cardiothoracic Surgery 6. Thoracic Surgery Procedures Lobectomy / Pneumonectomy / Wedge excision / Pleural biopsy / Plurodesis / Pleurectomy / Decortication / Rib resection / Pericardial window / Bullectomy / Diaphragm repair Plastic surgery 7. Unilateral breast surgery Neurosurgery Unilateral craniotomy / craniectomy / cranioplasty (forehead / mastoid) Unilateral burr hole(s) for ICP / chronic subdural haematoma / VP shunt (forehead) (Midline approach to cerebellar lesion or pituitary lesion does not require marking) 9

10 Urology 1. Scrotal surgery Unilateral hernia repair / hydrocele operation / Orchidectomy / Orchidopexy / scrotal exploration / varicocele operation / epididymal operation / other scrotal surgery 2. Bladder Surgery Unilateral deflux injection / Unilateral ureteric reimplantation Ureteric surgery reimplantation / stone surgery including endoscopic surgery / tumour resection surgery 3. Kidney Surgery Unilateral pyeloplasty / Unilateral nephrectomy / heminephrectomy / donor nephrectomy / stone surgery including PCNL Adrenal operation Paediatric Surgery 1. Scrotal surgery Unilateral hernia repair / High ligation of PPV / Orchidectomy / Orchidopexy / scrotal exploration / High ligation of varicocele 2. Bladder Surgery Unilateral deflux injection / Unilateral ureteric reimplantation 3. Kidney Surgery Unilateral pyeloplasty / Unilateral nephrectomy/heminephrectomy 10

11 Department of Surgery Prince of Wales Hospital The Chinese University of Hong Kong GENERAL SURGERY 1 Inguinal & femoral hernia repair (open or laparoscopic) Incisional / excisional biopsy of lymph nodes at groin 2 2 Thyroid Surgery (Hemithyroidectomy) Parathyroid Surgery Incisional / excisional biopsy of lymph nodes at supraclavicular fossa / cervical region 3 Procedure for varicose vein of legs Lumps & bumps excision over the torso or limbs CARDIOTHORACIC SURGERY 6 Thoracic Surgery Procedures Lobectomy / Pneumonectomy / Wedge excision / Pleural biopsy / Plurodesis / Pleurectomy / Decortication / Rib resection / Pericardial window / Bullectomy / Diaphragm repair 4 Adrenalectomy / Adrenal surgery 5 Incision and drainage for buttock (deep-seated ischiorectal fossa) abscess (Colectomy / proctectomy for cancer does not require site marking) PLASTIC SURGERY 7 Unilateral breast surgery SURGICAL SAFETY NEUROSURGERY Unilateral craniotomy / craniectomy / cranioplasty (forehead / mastoid) Unilateral burr hole(s) for ICP / chronic subdural haematoma / VP shunt (forehead) (Midline approach to cerebellar lesion or pituitary lesion does not require marking) UROLOGY PAEDIATRIC SURGERY 1 Scrotal surgery Unilateral hernia repair / High ligation of PPV / Orchidectomy / Orchidopexy / scrotal exploration / High ligation of varicocele 2 Bladder Surgery Unilateral deflux injection / Unilateral ureteric reimplantation 3 Kidney Surgery Unilateral pyeloplasty / Unilateral nephrectomy/heminephrectomy Scrotal surgery Unilateral hernia repair / hydrocele operation / Orchidectomy / Orchidopexy / scrotal exploration / varicocele operation / epididymal operation / other scrotal surgery 2 Bladder Surgery Unilateral deflux injection / Unilateral ureteric reimplantation Ureteric surgery reimplantation / stone surgery including endoscopic surgery / tumour resection surgery 3 Kidney Surgery Unilateral pyeloplasty / Unilateral nephrectomy / heminephrectomy / donor nephrectomy / stone surgery including PCNL Adrenal operation