Read about risk factors for wrong-site surgery in dermatology and strategies to prevent it. Also in this issue: new webinars on preventing infection in long-term care and patient safety in Pennsylvania, a video about CBD interactions with medication, and more.
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Wrong-Site Surgery in Dermatology:Report of PA-PSRS Data and Strategies for Prevention
What Is Wrong-Site Surgery?
Wrong-site surgery (WSS) is defined as a “surgical or other invasive procedure performed on the wrong side, site, or patient, or an incorrect procedure performed on the patient.”1-6 WSS has received decades of national and international attention, yet it remains as a persistent, preventable medical error. Pennsylvania mandates that licensed healthcare facilities report patient safety events, ranging from near misses to events resulting in serious harm or death, to the Pennsylvania Patient Safety Reporting System (PA-PSRS).7 As a result, staff at the Patient Safety Authority (PSA) have a long history of using patient safety event reports to study WSS, among many other topics.
PA-PSRS Reports of Dermatologic WSS Events
Staff at PSA recently conducted a study of 664 WSS event reports, from a 10-year period, that were submitted to PA-PSRS.8 Within that study, there were 20 reports associated with the dermatology specialty; 15 occurred at a hospital and five occurred at an ambulatory surgical facility. Of the 20 dermatologic WSS events, 19 were wrong-site errors, one was a wrong-side error, and none were a wrong-procedure or wrong-patient error. The study also found that the procedures most frequently associated with WSS were the following: Mohs micrographic surgery (8 of 20), excision (5 of 20), biopsy (4 of 20), curettage (2 of 20), and laser procedure (1 of 20).
The top three body regions most frequently associated with dermatologic WSS events were head/neck, chest/thorax, and upper extremity. Within the head/neck body region, there was a range of specific body parts that were involved, such as scalp, forehead, eyelid, ear, cheek, and neck.
Dermatologic Risk Factors for and Strategies to Prevent WSS
A 2013 survey of 150 dermatologists within the United States identified WSS as the “most serious” practice error.9 Given the nature of dermatologic practice and findings from prior research,8 many, if not all, dermatologic procedures pose risk for WSS. As a result, both healthcare providers and patients have roles in preventing WSS, which should involve joint consensus, not sole assertion, when identifying the correct procedure site.10 The site should also be confirmed with use of objective documentation, especially photographs and landmark measurements, to reduce ambiguity.11-13 Reducing the risk of WSS requires a multi-step approach involving physicians, their staff, and patients. Table 1 outlines risk factors for WSS in dermatologic procedures and strategies for prevention.
For more WSS findings and resources, see our article entitled “Wrong-Site Surgery: A Study of 664 Events From 237 Facilities Across a 10-Year Period” at doi.org/10.33940/001c.156001.
Upcoming Events
Just Published in Patient Safety
Balancing Autonomy and Duty: Challenges of Managing Intraoperative Consent Revocation
Informed consent obtained prior to a medical or surgical procedure signifies the patient’s (or their surrogate’s) permission to proceed. The process of informed consent ideally includes a two-way discussion between the patient and clinician about the procedure’s components, its individualized risks and benefits, and value alignment for the “prudent” patient. This discussion should also cover alternative options, such as other surgical procedures, medical treatments, or therapies. Additionally, the consent discussion should be in terms and language that can be understood by the patient.
While informed consent may be commonly viewed as a single pre-procedure step or obtaining a signature on a form, it is not a one-time event. Instead, informed consent is an ongoing, collaborative process between the patient and clinician. Even after consent is initially given and the procedure begins, patients retain the right to withdraw consent. This ongoing right to self-determination means that patients may elect to withdraw consent even after initiation of the procedure.
In cases where a patient attempts to withdraw consent mid-procedure, clinicians face several clinical and ethical challenges balancing patient autonomy with professional duty to avoid harm.
Watch on YouTube
Cannabinoid Drug Interactions: Awareness & Patient Safety
Join Paul Kocis, RPh, PharmD, MPH, clinical pharmacist at the Penn State Health Milton S. Hershey Medical Center Anticoagulation Clinic, for an informative review of cannabinoid drug interactions.
Survey data show that communication between adult patients and healthcare providers about cannabinoid (CBD) use is often limited, which may increase the risk of drug–drug interactions with prescribed medications. In addition, nonprescription cannabinoids and medical marijuana (cannabis) currently lack Food and Drug Administration–approved prescribing information and standardized resources for evaluating potential interactions with other medication.
