Principles for Reliable Performance of Correct-Site Surgery
If surgical facilities are to hold their gains in consistently performing correct-site surgery, these principles for reliable performance of correct-site surgery, identified by the Pennsylvania Patient Safety Authority during its Preventing Wrong-Site Surgery Project, should be consistently followed.
Principles for Reliable Performance of Correct-Site Nerve Blocks
These principles can aid in the reduction of wrong-site nerve blocks and help sustain implementation of clinical practices.
Evidence Base for the Principles
Facilities may wish to use this information to inform surgeons and anesthesiologists on the rationale behind implementing best practices for following the Universal Protocol.
Actions to Satisfy Universal Protocol and WHO Surgical Safety Checklist
This crosswalk, developed by the Pennsylvania Patient Safety Authority, includes best practices to prevent wrong-site surgery that are endorsed by the Joint Commission, the World Health Organization, and the Authority.
How Can You Prevent Wrong-Site Surgery?
Surgeons or facilities can provide this brochure to preoperative patients so that they understand why so many providers ask the same questions. Facility-specific logos or contact information can be added to personalize the brochure.
Gaining Insight into Wrong-Site Surgery
This educational poster can be used to raise awareness about wrong-site surgery.
Patients and Surgical Teams Work Together to Avoid Wrong-Site Surgery
This poster incorporates the elements of the Universal Protocol and the Authority's Principles for Reliable Performance of Correct-Site Surgery to reflect the patient's perspective of the preoperative verification process to avoid wrong-site surgery. Facilities providing surgical services can post this tool to encourage patients, surgeons, and surgical teams to use - and remain engaged - in the process.
Gap Analysis and Action Plan to Prevent Wrong-Site Surgery
This tool provides surgical teams with the opportunity to identify potential practice gaps as compared with the 21 evidenced-based principles issued by the Authority.
Self-Assessment Checklist for Program Elements
This checklist can be used to evaluate and monitor facility programs for preventing wrong-site surgery.
Self-Assessment Checklist for Wrong-Site Anesthesia
This checklist can be used to evaluate and monitor facility programs for preventing wrong-site anesthesia.
OR Scheduling Form
This sample form includes suggested elements pertinent to scheduling cases for the operating room.
Preoperative Checklist
This sample checklist includes suggested elements pertinent to checking patient information, medical documentation, and surgical information.
Time-Out in the OR
In 2008, the Authority conducted a contest for facilities to submit scripts for time-outs in the operating room. Entries were posted to the Authority website.
Day of Surgery: Standardized Independent Verification 1
This sample verification form includes elements pertinent to verifying patient information, medical documentation, and surgical information. It has been suggested that two independent healthcare providers independently verify the information and documentation before the start of the procedure.
Day of Surgery: Standardized Independent Verification 2
This sample verification form includes elements pertinent to verifying patient information, medical documentation, and surgical information. It has been suggested that two independent healthcare providers independently verify the information and documentation before the start of the procedure.
For Surgeons' Offices: What You Can Do to Prevent Wrong-Site Surgery
This sample surgeon's office tip card and checklist can help in checking for discrepancies among different parts of the patient's record so that they may be reconciled with the surgeon.
Observational Monitoring Tool
This monitoring tool, which has been adapted with permission from the Health Care Improvement Foundation, can be used to monitor cases in the operating room.
Observational Monitoring Tool for Wrong-Site Anesthesia
This monitoring tool can be used to observe regional or local anesthesia blocks in the operating room.
Compliance Monitoring Tool
This monitoring tool aligns observations with the goals and measurement standards associated with the 21 potential recommendations to prevent wrong-site surgery.
Monitoring of Preoperative Information from Surgeon's Office Available at First Encounter
This sample monitoring tool can be used to monitor 10 cases for availability of preoperative information during preadmission testing or preoperative admission.
Wrong-Site Surgery Error Analysis Form
Anyone faced with a wrong-site surgery near miss or occurrence in his or her facility is encouraged to use this form to aid in the analysis.
Wrong Ureter Analysis Form
This form is an addendum to the "Wrong-Site Surgery Error Analysis Form" and should complement the main form, as applicable.
Wrong Spinal Level Analysis Form
This form is an addendum to the "Wrong-Site Surgery Error Analysis Form" and should complement the main form, as applicable.