Michelle Lemmons, RN, BSN, PHN, CNOR, CCSVP
Clinical Educator, OR
Have you ever driven home from work, pulled into your driveway, and asked yourself… how did I get here? Not literally, you know you drove, but you were in a mental state of “checked out”. The term for this checked out phenomenon is “highway hypnosis” and it is common to experience with the things you do frequently. In the operating room one thing we practice frequently: The Universal Protocol.
Since 2004, hospitals and surgeons have had to comply with the Universal Protocol as a tool to avoiding wrong site surgeries. Since 2009, Centers for Medicare and Medicaid (CMS) have not reimbursed a hospital for any costs associated with a wrong-site procedure as an incentive to avoid these errors at all costs. Still, according to the Joint Commission there are 40-60 wrong site procedures per week in the United States.
The Universal Protocol consists of three main “checks” to prevent wrong site surgery.
First step: The pre-procedure verification process - ensuring the correct procedure, for the correct patient, at the correct site. This initial step is also intended to reveal and address any missing information or discrepancy prior to medicating the patient, bringing them to the OR, or starting the procedure.
Second step: Mark the procedure site - marking the site with a consistent, unambiguous, sufficiently permanent mark or initial at or near the procedure site. The surgeon is responsible for this marking, even if it is delegated to another qualified team member.
Third step: The Universal Protocol requires that a time-out be performed to verify the correct patient, correct site, and correct procedure to be completed. Every team member present at the start of the case must participate.
To all perioperative staff - your attention is valuable. So how do you recalibrate your attention to the routine, repeat tasks you perform multiple times a day? Practice! Pause, re-center your attention on the room, the patient, the words on the chart. Defeat the highway hypnosis in the operating room!