Systematic review
Surgical intervention is one of the critical components in the field of medical practice. All surgical procedures aim at positive outcome, but is not the case in all procedures done. There are cases reported where complications arise that do not stem from the main or primary illness, but from procedural intervention during surgery. The main causes of these complications include wrong person surgery, wrong site surgery and wrong site marking. In regards to the commonality in these occurrences, various research articles have aimed to address these issues. The articles indicates that wrong site surgery is a rare occurrence, but once it happens, the consequences are very severe to the patient and to those performing the surgical procedure. The seriousness of this issue is evident in cases where a working organ is removed instead of the damaged one like in the case of kidneys. It is, therefore, a really serious issue that needs to be dealt with the seriousness it deserves.
The data from the articles show that wrong site surgery happens more frequently than people assume according to Hainsworth, (2005), one in every three nurses working in a theatre have ever worked in a surgical theatre where a wrong site procedure has taken place. The alarming rates of occurrences of wrong site surgery in various pre-surgical checks where patient safety issues were identified amounted to forty-four percent of the total sample taken. The articles point out that some of thekey sources of wrong-site surgery include lack of a standard method of marking surgical sites. The lack of standard methods leads to immense mistakes before the operations that result in wrong site surgery. As a result, most of the wrong-site surgical procedures occur due to mistakes that occurred before the surgery. The role of marking sites is the role of the surgeon who will perform the procedure. However, everyoneincluding nurses have a role to make sure that the surgical mark is at the right spot.The other major cause of wrong site surgery is lack of standard methods for conducting pre-surgical checks that is one major cause of error. As stated earlier, there are 44% of pre-surgical patient safety issues in health facilities. Patient safety is paramount in any clinical procedure, and the need to ensure that everything is done in a safe and secure manner is important in ensuring that patients are safe before, during and after the surgery.
Integrative review
Concerns are also raised in the articles over the high levels of nurse turnouts that results in unfamiliarity with the process of executing these checks. As a result, the checklist may not be effective though the procedures provided in the list have been executed well. The recommendations include various check procedures that aim at ensuring that everything goes well, and there are minimum cases of wrong site surgeries (Hainsworth, 2005). The first check recommended is to be done by the head surgical or the deputy who will be present during the surgical procedure and this should be performed in the ward a day before the operation. The articles also provide that there is need for the surgeon or the deputy to counter check the patient’s identity to make sure that he or she is the right person undergoing the operation. There is also a need for the surgeon to make sure that they double check the documented images on the site to be operated.
The second check should be done by the ward staff who have to make sure of the identity of the patient before he or she leaves the ward for the theatre and making sure they have the right images and documentations with the to the theatre. The third check recommended in the articles is a check by the operating surgeon done in the anesthetic room to ensure the correct mark against the documentation and the correct identity of the patient. There is also a need for the surgeon, the ward staff, and the team going for the surgery procedure to ensure that the marking is correct. The pen used to mark the site should be indelible to ensure that the mark remains intact before the operation. The mark should also be an arrow that extends near to, at the exact point where the incision site is located (Makary et al., 2007).
It is also apparent that lack of proper communication between the pre-operative and the operative teams. As a result, the teams may fail to pass vital information about the surgical procedure or some details about the patient that are key in ensuring a safe and right surgical procedure. It not only eliminates the threat to the patient, but the stress and anxiety the family and friends of the patient go through incase of a wrong site surgery.
The main concerns, therefore, should be centered on the ability of the nurses and other staff to work on the checklist in a practical manner instead of the theoretical view provided in the articles. It is not easy for nurses to adapt to the new procedures after a turnover (Treadwell,Scott&Tsou, 2014). This checklist, therefore, poses a huge problem. It may require new procedures to help reduce the number of nurse turnovers in theatres. Reduction of nursing turn-over will ensure that the evidence-practice gap is minimized as the nurse will be familiar with the checklist and what is expected of him or her. Human errors are also major contributing factors in the high cases of wrong site surgery. Some of the key factors that the articles recommend include regular training of medical personnel to ensure that they are up to date on some of the key issues arising in the medical procedures(Kwaan et al., 2006). This training will also go a long way to ensure that the personnel are competent when it comes to executing theoretical values to practical experiences that will in turn improve the safety of patients. All these will help reduce cases of wrong site surgery in the medical field. Nurses and surgeons will be competent in provision of various services that aim at improving the health conditions of the patients and not increasing their risk of getting complications before or after the surgery.The articles cite that there is need for future research to address some of the key issues especially in regards to efficiency of OR and the indirect harms caused by the adaption of the checklist.
The current state of wrong site surgical procedures is lack of proper measures to ensure that everything is done according to the requirements of medical procedures. As a result, the articles come up with various recommendations that will help reduce cases of wrong site surgery. After the implementation of the recommendations, there has been a reduction in the rate of lower respiratory tract infections due to the presence of various checklists to guide in the various procedures for the staff working in the surgical procedure. The reduction is, however, cited by these articles to be on direct harms only. Claims of potential harms like the reduction in the efficiency of OR may lead to an increase in the anxiety levels for patients undergoing the surgery. It is also noted in the articles that the checklists are not relevant in emergency cases. The time needed to perform the checklists is not available; hence it results in inconveniences if one decides to follow them (Saufl, 2004).
There is one major inconsistency and contradiction in the articles on the proper checklists to be used by the nurses and other surgical staff before and during the surgery. There are different proposed checklists that make it difficult to understand and stick to on. This may possibly be due to the various bodies trying to come up with ways of reducing cases of wrong site procedures. The evidence provided in these articles show that there is need for implementing changes in the surgical procedures in order to reduce cases of wrong site surgeries. The articles articulate that the concerned parties have to ensure that they use the present evidence from research to conduct checklists and work on minimizing these cases. However, future research is also required to ensure that there is sufficient research on the topic and proper measures that will help in reducing or eliminating cases of wrong site surgery.
References
Hainsworth, T. (2005).The NPSA recommendations to promote correct-site surgery.Nursing
Times Journal,101(12), 28–29.
Kwaan, M. R. et al. (2006).Incidence, patterns, and prevention of wrong-site surgery. Archives of surgery,141(4), 353-358.
Makary, M. A.et al. (2007). Operating room briefings and wrong-site surgery. Journal of the American College of Surgeons, 204(2), 236-243.
Saufl, N. M. (2004). Universal protocol for preventing wrong site, wrong procedure, wrong
person surgery. Journal of PeriAnesthesia Nursing, 19(5), 348-351
Treadwell, J. R., Scott, L., & Tsou, Y. A. (2014).Surgical checklists: a systematic review of
impacts and implementation.BMJ Qual Saf, 23, 299-318.
