universal protocol1

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The Medical City UniversalProtocol to Prevent Wrong

Patient, Wrong Site Procedures

A Test of True

Teamwork



This is a one hour training

workshop! Brief Talk: 20 minutes

Clarifications: 10 minutes

Role play: 15 minutes

Q and A: 10 minutes

Take home messages: 5 minutes60 minutes



This can happen to you!!! Patient is wheeled into the OR for

arthroscopy, sedated. His right knee is

prepped and draped. Surgeon finds outlater it¶s the WRONG KNEE.

Patient answers to wrong name whencalled and gets a MRI of the lumbar spine.He is for CT scan of the abdomen.

Doctor writes ³right´ instead of ³leftbreast´. Patient is biopsied on the wrong

side.



Why mix-ups can occur The trip from nursing floors to the

Operating Room or RadiologyDepartment is a relay of patients

and patient informationperformed by overloaded, time-pressured, multi-tasking,distracted doctors, nurses,transport and admin staff.

At the procedure site,

moderated chaos reigns.



The goal of the Universal Protocol To eliminate wrong patient, wrong site

surgical, radiologic and other

procedures To establish team work among

members of the surgical / radiologic

team wherein any member of the teamfeels accountable for the outcome of the procedure and empowered to ³SEE

IT, SAY IT, FIX IT´.



Communication: the critical skill

targeted by the Universal Protocol Staff must ask patients their name, what

procedure they consented to and which site.

Staff must ensure that every member of the

team gets the patient¶s name, procedure and

site RIGHT.

Staff must SPEAK UP if something feels or appears wrong, no matter how silly they may

feel to say something.




targeted by the Universal ProtocolSEE IT!

Be alert to anything that feels or appears wrong

SAY IT!

SPEAK UP without deference to authority or seniority.

FIX IT!

Stop, ascertain patient¶s identity, the procedure heconsented to and which site.

All members of the team must agree 100% beforegoing ahead with procedure.



The 3 components of the

Universal Protocol Preoperative verification

Marking the operative site

Time out just before performing the

procedure



Preoperative verificationWith the patient fully conscious, NURSE

must ask

1. ³May I know your name again?´

2. ³What procedure are you scheduled to

undergo?´

3. ³Which side (if bilateral) or site (if

multiple lesions or levels) will the

procedure be done?´



Preoperative verificationNURSE must endorse to transport staff

1. ³Patient¶s name as given by patient

matches our patient identifiers.´

2. ³Scheduled procedure matches informed

consent signed by patient.´

3. ³Side (if bilateral) or site (if multiple

lesions or levels) matches informed

consent.´



Preoperative verification NURSE must NOT depend solely on

doctor¶s admitting orders or request for

procedure.

They can be wrong.

Confirm with the patient or relatives. This

is patient partnership carried out for avery important reason: to avoid errors.

If there is conflicting information, call the

AP immediately.




targeted by the Universal Protocol

SEE IT!


SAY IT! SPEAK UP without deference to authority or

seniority.

FIX IT!





Marking the procedure site.

MD doing procedure

must mark all cases

involving right/leftdistinction, multiple

structures (fingers,

toes), multiple levels(spine) or multiple

lesions




Done BEFORE

patient leaves pre-

procedure area /ward

Done with full

knowledge of patient Mark must be visible

after prepping and

draping




The Medical Citystandard mark is an

arrow placed near or at the intendedincision site witharrow heads and a

circular mark aroundthe perimeter of thelesion or organ to beexcised.

OR

OR



Calling for a TIME OUT

Before performing theprocedure, the surgeon

or radiologist must makea declaration to theentire team

Patient¶s name is«««««««

He has consented to a««««««« whichwill be performed on the«««««(side / site).

All teammembers must agree100% with

- The patient¶s correctidentity

- The correctplanned procedure

- The correctsite of plannedprocedure

- The correct signedinformed consent for the



Calling for a TIME OUT

The following must certify that a Time Outwas declared by signing the time out

section of the checklist1. The patient¶s anesthesiologist or surgeon or radiologist

AND2. The circulating nurse or radiologictechnologist.





SEE IT!



seniority.

FIX IT!





Now let¶s practice

We need 10 volunteers for scenario 1

A patient

A surgeon An anesthesiologist

A nurse in charge

A transport staff

A PARU nurse

A circulating nurse

3 evaluators who will assess effectiveness of

execution of Universal Protocol



Scenario 1 (role playing time: 5 min)

Patient is diabetic and is being treated for

sepsis and gangrenous foot (left). He is

due for amputation of the foot below theknee.

Act out the Universal Protocol at the

following scenes: Scene 1: the Nursing Floor

Scene 2: PARU

Scene 3: the Operating Theater.



Scenario 1 (group processing time:10 min)

At end of simulation, evaluators and restof audience must rate effectiveness of

team members in complying with theUniversal Protocol.

In which of the 3 scenes is relay of patientinformation problematic? Why?

Which parts of the Protocol arechallenging to execute? What systemchanges are needed to address these

challenges?



Shall we practice some more?

We need 9 volunteers for scenario 2

A patient

A radiology consultant A radio resident

A receiving clerk

A radio tech

A radio nurse

3 evaluators who will assess effectiveness of execution of Universal Protocol



Scenario 2 (role playing time: 5 min)

Patient (not admitted) has multiple colloid

adenomatous goiter and is being referred

for ultrasound guided biopsy of the rightlobe.

Act out the Universal Protocol at the

following scenes: Scene 1: the Radiology Reception Area

Scene 2: the Radiology Procedure Room.



Scenario 2 (group processing time:10 min)

At end of simulation, evaluators and restof audience must rate effectiveness of

team members in complying with theUniversal Protocol.

In which of the 3 scenes is relay of patientinformation problematic? Why?

Which parts of the Protocol arechallenging to execute? What systemchanges are needed to address these

challenges?



The 3 components of the

Universal Protocol

Successful relay of patientinformation begins and ends

with team work.Teamwork is critical in

Preoperative verification

Marking the operative site Time out just before

performing the procedure





SEE IT!



seniority.

FIX IT!



universal protocol1

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