Total Hip Replacement (THR) Quality Measures
Wrong-patient, wrong-procedure, or wrong-site surgeries
are uncommon, but they can be avoided altogether by following careful procedures
prior to surgery. The following procedures cover broad areas of concern in
preventing surgical mishaps; however, there are additional safeguards used
by surgical teams that are not listed here.
The first procedure involves review
of relevant medical records prior to surgery. These records may contain information
that will prevent the need for additional tests, saving time and money. They
may also provide vital facts about your health history that your surgical team
needs to know.
Secondly, according to the Joint
Commission on Accreditation of Health Care Organization's (JCAHO) Universal
Protocol for Prevention of Wrong Site, Wrong Procedure, Wrong Person Surgery,
it is recommended that the operating surgeon mark the operative site using a
signature or other approved mark.
Extra care should be taken with moist areas that can smear
onto another site such as the inside of the thigh, according to a report in
Anesthesia and Analgesia (January 2005; 100 (1): 300). Smearing can occur where
marked skin touches unmarked skin and the unintended marks may cause confusion
about the correct site for surgery.
Lastly, just prior to surgery a final review
is performed to ensure that the right patient is having the right procedure
on the right body part, with all necessary patient information available. The
armband may be checked several times during this process to verify that the
team has the correct patient.
An opportunity for speaking up is provided during
this final review; it is a built-in pause (time-out) to provide an opportunity
for anyone on the surgical team to speak up about anything related to the procedure
or patient that is questionable.
At St. Mary's Hospital Medical Center, the following steps are taken to ensure correct-patient,
correct-procedure and correct-site for hip surgery:
- review of relevant medical records prior to surgery
- marking operative site with non-smearing signature or other approved mark
- armband check