Accompanied by an undergraduate student nurse on clinical placement who you are precepting, you initiate sign-in of a 15-year-old female in the OR where you are the circulating nurse. The patient is to undergo a closed reduction of fractured left radius under general anaesthetic. The student asks you to explain the WHO Surgical Safety Checklist (SSC) with particular reference to patient
identification. How would you address this request? Include rationales for your answers.
What will be an ideal response?
Answer:
Ensuring the correct patient undergoes the correct procedure at the correct site requires a systematic approach.
Rationale: This is necessary because there have been occasions when an incorrect procedure has been performed and/or the wrong patient has undergone surgery.
Where feasible, the patient should be part of the Sign In process. The SSC utilises a three-stage process (Sign in, Time out, Sign out) and Sign in should occur in the presence of the patient (where feasible). (In some cases it may not be feasible to include the patient in the process e.g. if they are unconscious, or if they are a minor.)
Rationale: This is because the patient knows who she is, what procedure is planned and which side is to be operated on.
During Sign in, all activity must cease and then the circulating nurse confirms the presence of the correct patient.
Rationale: This is the final opportunity to ensure that it is the correct patient on the OR table because after that the patient will be anaesthetised and unable to respond to questions.
Additionally, the circulating nurse confirms the planned procedure, that the operative site has been marked, consent obtained and any allergies the patient may have are brought to the attention of the surgical team.
Rationale: This is the final opportunity to ensure that the procedure is the planned one, that the correct site (left forearm) is marked and the patient's allergy status is known prior to the patient being anaesthetised.
The final activities on the SSC are as follows:
Completion of the anaesthesia safety check—this is confirmation that the anaesthetic machine has been checked and that any patient medications have been given.
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