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Clinical Issues JANUARY 2009, VOL 89, NO 1
AORN JOURNAL • 199
REFERENCES1. HR6111 Tax Relief and Health Care Act of 2006:Sec 101 Physician Payment and Quality Improve-ment. Centers for Medicare and Medicaid Services.
QUESTION: We know that in 2009, the Joint Com-mission Universal Protocol™ will be revised in theNational Patient Safety Goals (NPSGs). Currently,we conduct the time out before starting the proce-dure, usually before the anesthesia process is initi-ated. In instances in which two or more proceduresare being performed on the same patient, when isthe time out performed for each procedure?
ANSWER: The 2009 Joint Commission NPSGUP.01.03 elements of performance state that thetime out should be performed immediately be-fore the start of a procedure:
The purpose of the time-out immediately beforestarting the procedure is to conduct a final as-sessment that the correct [patient], site, position-ing, and procedure are identified and that, as applicable, all relevant documents, related infor-mation, and necessary equipment are available.1
The Universal Protocol for 2009 providesunambiguous guidance for when two or moreprocedures are performed on the same pa-tient: a time out is performed to confirm eachsubsequent procedure before it is initiated.1
Additionally, safety can be enhanced when allteam members suspend activities and focustheir attention on confirmation of the correctpatient, correct site, and other critical elementswith the patient identifiers and consent.
The Joint Commission’s Universal Protocolis applicable to every perioperative setting (eg,
office-based facilities, ambulatory surgery cen-ters, dental/maxillofacial facilities, interven-tional radiology suites, endoscopy laborato-ries) where operative and other invasive pro-cedures are performed, including facilities notaccredited by the Joint Commission.
The 2009 NPSGs delineate other recommen-dations to reduce the risk of errors during inva-sive procedures. Health care organizations in allsettings should incorporate these recommenda-tions into policies and practice together withother risk-reduction strategies. Example include • an interactive, team communication approach
that eliminates complacency and rote execu-tion of the time out;
• briefing checklists that foster thorough inclu-sion of critical items that must be verified; and
• simulation training that hones the briefing pro -cess, aligns perceptions, and improves commu-nication skills while promoting a team culture.A wealth of tools and guidelines are available
for educating staff members and assisting withimplementation of policies to promote perioper-ative patient safety, regardless of the accreditingagency used by the organization. The WorldHealth Organization has published a practicalimplementation guide and one-page surgicalsafety checklist for implementing the time-out.2
The AORN Correct Site Surgery Tool Kit3 isavailable at no cost to members and can be usedto implement the Joint Commission’s UniversalProtocol. Successful patient outcomes can beachieved with deliberate education, knowledge,
http://www.cms.hhs.gov/PQRI/Downloads/PQRITaxReliefHealthCareAct.pdf. Accessed November24, 2008.2. ACS Quality Measures: Implementation Guide(Version 1.0). ASC Quality Collaboration. http://www.ascquality.org/documents/ASCQualityCollaborationImplementationGuide.pdf. AccessedNov ember 11, 2008.3. National voluntary consensus standards as ofOctober 29, 2008. National Quality Forum. http://www.qualityforum.org/pdf/Btblendorsedmeasurescurrent.xls. Accessed November 12, 2008.4. Stanton C. New tools to promote ASC quality.AORN Management Connections. April 2008. http://www.aorn.org/Managers/April2008Issue/NewToolsToPromoteASCQuality. Accessed November 11, 2008.
When to perform the surgical time out
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JANUARY 2009, VOL 89, NO 1 Clinical Issues
communication, and development of a function-al team cul ture.
Editor’s note: The Universal Protocol for Preven -ting Wrong Site, Wrong Procedure, Wrong PersonSurgery is a trademark of the Joint Commission,Oakbrook Terrace, IL.
SHEILA MITCHELLRN, BSN, MS, CNOR
PERIOPERATIVE NURSING SPECIALIST
AORN CENTER FOR NURSING PRACTICE
REFERENCES1. 2009 National Patient Safety Goals Hospital Pro gram. Joint Commission. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/09_hap_npsgs.htm. Accessed Nov-ember 11, 2008.2. Surgical safety checklist. The World Health Organization. http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Checklist_finalJun08.pdf. Accessed November 11, 2008.3. Correct Site Surgery Tool Kit. AORN, Inc.http://www.aorn.org/PracticeResources/ToolKits/CorrectSiteSurgeryToolKit. Accessed Nov-ember 11, 2008.
200 • AORN JOURNAL
Editor’s note: At various times throughout the year, the Recom mended Practices Committee seeksreview and comment on proposed recommended practices from members and other interested indi-viduals. When available, these proposed recommended practices appear online at http:// www.aorn.org. Proposed recommended practice documents are available for review and comment for a30-day period after they are posted. Interested individuals who do not have access to the Internetmay obtain copies of the proposed documents by calling the Center for Nursing Practice at (800)755-2676 x 334. A deadline for comments is indicated with each document. Please check thesesources frequently to locate proposed recommended practices. All comments received are consideredas the document is finalized. Thank you for your participation.
If you know of a colleague who has passed awaysince the March 2008 Congress, President Susan
K. Banschbach, RN, MSN, CNOR, encourages you tosubmit his or her name to AORN headquarters.Names of those to be remembered will be displayedduring the Opening Session at the 2009 Congressin Chicago, Illinois.
Send names to the attention of Mary Lopez by faxat (303) 750-2927, by e-mail to [email protected], or
by mail to 2170 S Parker Rd, Suite 300, Denver, CO80231-5711. Please include the individual’s firstname, middle initial, last name, city, and state. Besure to verify that spelling is correct and that allhandwritten submissions are legible. If you submit aname by e-mail, please type “Congress 2009 Project”in the subject line. To ensure inclusion, all namesmust be received by Mary no later than Monday,February 9, 2009.
Remembering Our AORN Colleagues
Make plans now to attend AORN Congress in up-coming years. Following is a list of future Con-
gress dates and locations:• 2009—March 15 to 19, Chicago, Illinois
• 2010—March 14 to 18, Denver, Colorado• 2011—March 19 to 24, Philadelphia, Pennsylvania• 2012—March 25 to 29, New Orleans, Louisiana• 2013—March 3 to 7, San Diego, California
Future Congress Dates and Locations
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