Patient Safety: Surgical Errors and Their Prevention

Since this is Patient Safety Awareness Week, I'm addressing safety problems each day to create awareness of safety problems and what can be done to prevent them.

Surgical errors are legend. We've all heard stories about surgical instruments, sponges, even needles being left inside a patient. At times, the wrong patient has been wheeled into the operating room. Tales abound about someone getting the wrong limb amputated, or the wrong kidney removed. There are even incidences of patients catching fire while being cauterized (when an opening is burned shut).

Surgical errors are listed among the National Quality Forum's "never events," events that should never take place in a healthcare setting. They don't happen often -- perhaps 25 or 30 per year -- but if you are the person who has been harmed, it has made all the difference for the rest of your life.

While most of these kinds of safety problems are out of the control of patients, there are some things that can be done by patients to prevent them. Here are some ideas to help patients have more confidence in their surgeons:

• Discuss the surgery thoroughly with your surgeon. Make sure you and your surgeon agree on what body part will be operated on, if you have more than one of them (a right leg and a left leg, for example) then make sure you agree on which is the right one. Don't forget -- the leg on your right is the leg on your surgeon's left.
• Ask the anesthesiologist if you can remain conscious during the surgery. This won't be an option for all kinds of surgery, but having a spinal or an epidural may allow you to stay awake without pain. You'll be able to somewhat monitor what's going on, and you'll be able to respond to the surgeon if she asks you questions.
• If appropriate, and using an indelible marker (like a sharpie) mark the area on your body that is correct prior to the surgery. "This knee" or "this shoulder." And -- mark the side that is NOT correct. "Wrong knee" or "wrong shoulder" will alert the surgeon that he's looking at the wrong one. While you're at it, and if you know you'll need to be asleep, then write your name somewhere near the area that will be opened up, too.

The Joint Commission, the body that accredits hospitals, has developed a "Universal Protocol" for surgeons and others involved in surgery. It calls for the use of check lists and time-outs to confirm the right patient and the right body part. This protocol was developed specifically to reduce the number of errors.

Ask for copies of your surgical records after any surgery. If you have trouble in recovery, or you think an error may have occurred, you need to discuss it immediately with your surgeon. If the answers don't add up, or if you think your surgeon is avoiding you, make an appointment to have someone else review the surgery and the notes. Your goal should be to get well first. If appropriate, blame or litigation can come later.

Being aware of the perils of surgeries will help you, the savvy patient, do everything in your power to avoid problems.
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