Universal Protocol
When the nurse is doing the pre-procedure verification process, what items need to match the surgery description word for word?
Consent, Surgery Orders, Surgery Schedule
What do the AORN guidelines state needs to be reflected in a Time Out?
Patient Identity
Site and Side of Surgery
Verification of the procedure to be performed
During the preprocedure interview, the RN discovers that the verbiage on the consent does not match the verbiage on the surgery schedule, what should the RN do?
The invasive procedure preparation process should be halted until the conflict is resolved.
What word is the only acceptable site marking?
Yes
Site marking is required when the individual doing the procedure is continuoulsly with the patient from the time of the decision to do the procedure through the performance of the procedure.
True or False
False, it is not required if the surgeon is with the patient
What are the three steps in Universal Protocol?
Pre-procedure verification process
Site marking
Time-Out
Dr Rayhanabad is performing a mastectomy and Dr Hurvitz will be placing expanders on the same patient. In regards to the time out, when is it said and how does it differ from a single case?
When two or more procedures are being performed on the same patient, a time-out is performed to confirm each subsequent procedure before it is initiated.
Who should be involved in the pre-op verification?
When possible, the verification should involved the patient, or the guardian
Who can do the site marking?
The procedure site is to be marked by a licensed independent practitioner or other provider who is privileged or permitted by the hospital to perform the intended operative or invasive procedure.
It is okay for a patient to refuse a site marking
True or False
True
If they refuse, you need to apply an orange armband with their name, DOB and procedure site
When the patient enters the room, the RN circulator performs the "Briefing". What is included in the "Briefing"?
Name of the patient, The procedure to be performed, the site/side of the procedure, patient positioning, implants and radiological exams that are applicable
Dr Branche will be doing a block in the Operating Room, on the left knee prior to the surgical procedure. What needs to take place before he can do the block?
How do you interview your patient if they are Spanish speaking only?
Call language line, or use the iVic
What are some exceptions to the rule of site marking?
Premature infants
When a patient refuses to allow marking of the site
Single organ cases
Interventional procedure cases in which the catheter/instrument
Insertion site is not predetermined
There is an obvious wound or lesion that is the site of the intended procedure
Using a marker on a premature infant may cause a permanent tattoo on their skin
True
It may cause a permanent tattoo, so an orange armband may be used
When is the debriefing done?
At the end of the surgical case and before the primary surgeon and the patient have left the room
During the Time-Out, what is everyone to be doing?
During the time-out, other activities shall be suspended, to the extent possible without compromising patient safety, so that all participating members of the team are focused and can provide a verbal confirmation
When a Transport PCA picks up a patient from the floor, what is the necessary to do to confirm they have the correct patient?
Name
Medical Record #
If the patient is having a procedure where they should be marked, but cannot be marked because they are refusing or the site cannot be marked; what should you do?
An orange armband will be applied by procedure nurse or designee which includes the patient’s name, date of birth and invasive procedure sites
When reading a Time Out, only the RN Circulator can initiate the Time Out?
True or False
False
Any active person involved in the case can initiate the Time Out
Name 4 of the 8 items that are discussed in a debriefing?
Correct counts, Confirmation of surgical procedure, wound class is reviewed, specimen identification and labeling, blood loss discussion, recovery issues reviewed, team consensus that all items used in the surgical field have been accounted for and any lessons learned.
When can a procedure begin?
After all active participants, involved in the procedure have confirmed the patient's identity, site and side and the procedure to be performed
On the EPIC checklist, what 3 of the 5 items that the Pre-op/OR Nurse needs to confirm have been populated before the patient leaves the pre-op area?
Surgical site marked, Universal protocol initiated, Location of informed consent, Anesthesia consent signed, Receiving unit checklist verification completed
What is the correct location of the word "yes" when a surgeon is marking the site?
The mark is positioned to be visible after the patient has his or her skin prepped, is in his or her final position, and sterile draping is completed.
The completed Time Out shall be documented in the patient's medical record
True or False
True