[ST-62] Statement on surgical patient safety

[by the American College of Surgeons]

This statement was developed by the Board of Governors’ Committee on Surgical Practice in Hospitals and Ambulatory Settings. It was approved by the Board of Governors and by the Board of Regents in October 2008.

The American College of Surgeons regards patient safety as a top priority and strongly urges individual hospitals and health care organizations to develop guidelines to ensure optimal patient safety in the operating room. The use of a “team approach” has been shown to be highly effective.* However, this approach requires the engagement of all parties involved in the surgical process. Since lack of communication and failure to coordinate care are the most common causes of medical errors, the incorporation of team-based practice through institutional team training is desirable.

Each institution is encouraged to develop its own method of preoperative and postoperative briefing and debriefing (for example, http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Checklist_finalJun08.pdf). Proper identification of the patient and procedure and confirmation of the consent form and the surgical site should be mandatory. If multiple separate procedures are scheduled, the checklist must be verified prior to each planned procedure. All relevant records and imaging procedures should be present. If any verification process fails to identify the correct site, patient, or critical items needed, the operating room activity should be halted at an appropriate time until verification and procurement are complete.

The American College of Surgeons recognizes that the use of computerized medical records and bar-coding of drugs and blood products are highly desirable throughout all perioperative areas. Computerized preference cards are encouraged to avoid multiple trips of support staff from the operating room during the procedure. It also is important that during each individual procedure there be a team-designated “no handoff time” when certain members of the team will not be changed. This process can be determined separately in each institution and by each surgical service involved. Safety mechanisms, as recommended by the American College of Surgeons and The Joint Commission—including, but not limited to, double-gloving, blunt-tip suture needles, neutral zones, and protective sharps devices—should be encouraged.^†The American College of Surgeons condemns disruptive behavior from any member of the operating room team, as such behavior jeopardizes patient safety.

To enhance patient safety, it is the responsibility of the surgeon to oversee proper preoperative preparation of the patient; obtain informed consent; confirm with the team the diagnosis and agreed-upon operation; perform the operation safely and competently, including planning with the anesthesia professional the optimal anesthesia method for the patient; provide postoperative care of the patient, including personal participation in the direction of this care and management of postoperative complications should they occur; and disclose information to the patient or patient’s representative relative to the conduct of the operation, operative and pathological findings, procedure forms, and the expected outcome.

*World Alliance for Patient Safety. WHO Guidelines for Safe Surgery. Available at: http://www.gawande.com/documents/WHOGuidelinesforSafeSurgery.pdf. Accessed November 20, 2008.

^†Statement on sharps safety [ST-58]. Bull Am Coll Surg. 2007;92(10):34-37.

Reprinted from Bulletin of the American College of Surgeons
Vol.94, No. 1, January 2009

Statements