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Transcript of Universal Protocol1
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 1/29
The Medical City UniversalProtocol to Prevent Wrong
Patient, Wrong Site Procedures
A Test of True
Teamwork
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 2/29
This is a one hour training
workshop! Brief Talk: 20 minutes
Clarifications: 10 minutes
Role play: 15 minutes
Q and A: 10 minutes
Take home messages: 5 minutes60 minutes
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 3/29
This can happen to you!!! Patient is wheeled into the OR for
arthroscopy, sedated. His right knee is
prepped and draped. Surgeon finds outlater it¶s the WRONG KNEE.
Patient answers to wrong name whencalled and gets a MRI of the lumbar spine.He is for CT scan of the abdomen.
Doctor writes ³right´ instead of ³leftbreast´. Patient is biopsied on the wrong
side.
8/8/2019 Universal Protocol1
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Why mix-ups can occur The trip from nursing floors to the
Operating Room or RadiologyDepartment is a relay of patients
and patient informationperformed by overloaded, time-pressured, multi-tasking,distracted doctors, nurses,transport and admin staff.
At the procedure site,
moderated chaos reigns.
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 5/29
The goal of the Universal Protocol To eliminate wrong patient, wrong site
surgical, radiologic and other
procedures To establish team work among
members of the surgical / radiologic
team wherein any member of the teamfeels accountable for the outcome of the procedure and empowered to ³SEE
IT, SAY IT, FIX IT´.
8/8/2019 Universal Protocol1
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8/8/2019 Universal Protocol1
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Communication: the critical skill
targeted by the Universal Protocol Staff must ask patients their name, what
procedure they consented to and which site.
Staff must ensure that every member of the
team gets the patient¶s name, procedure and
site RIGHT.
Staff must SPEAK UP if something feels or appears wrong, no matter how silly they may
feel to say something.
8/8/2019 Universal Protocol1
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Communication: the critical skill
targeted by the Universal ProtocolSEE IT!
Be alert to anything that feels or appears wrong
SAY IT!
SPEAK UP without deference to authority or seniority.
FIX IT!
Stop, ascertain patient¶s identity, the procedure heconsented to and which site.
All members of the team must agree 100% beforegoing ahead with procedure.
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 9/29
The 3 components of the
Universal Protocol Preoperative verification
Marking the operative site
Time out just before performing the
procedure
8/8/2019 Universal Protocol1
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Preoperative verificationWith the patient fully conscious, NURSE
must ask
1. ³May I know your name again?´
2. ³What procedure are you scheduled to
undergo?´
3. ³Which side (if bilateral) or site (if
multiple lesions or levels) will the
procedure be done?´
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 11/29
Preoperative verificationNURSE must endorse to transport staff
1. ³Patient¶s name as given by patient
matches our patient identifiers.´
2. ³Scheduled procedure matches informed
consent signed by patient.´
3. ³Side (if bilateral) or site (if multiple
lesions or levels) matches informed
consent.´
8/8/2019 Universal Protocol1
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Preoperative verification NURSE must NOT depend solely on
doctor¶s admitting orders or request for
procedure.
They can be wrong.
Confirm with the patient or relatives. This
is patient partnership carried out for avery important reason: to avoid errors.
If there is conflicting information, call the
AP immediately.
8/8/2019 Universal Protocol1
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Communication: the critical skill
targeted by the Universal Protocol
SEE IT!
Be alert to anything that feels or appears wrong
SAY IT! SPEAK UP without deference to authority or
seniority.
FIX IT!
Stop, ascertain patient¶s identity, the procedure heconsented to and which site.
All members of the team must agree 100% beforegoing ahead with procedure.
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 14/29
Marking the procedure site.
MD doing procedure
must mark all cases
involving right/leftdistinction, multiple
structures (fingers,
toes), multiple levels(spine) or multiple
lesions
8/8/2019 Universal Protocol1
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Marking the procedure site.
Done BEFORE
patient leaves pre-
procedure area /ward
Done with full
knowledge of patient Mark must be visible
after prepping and
draping
8/8/2019 Universal Protocol1
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Marking the procedure site.
The Medical Citystandard mark is an
arrow placed near or at the intendedincision site witharrow heads and a
circular mark aroundthe perimeter of thelesion or organ to beexcised.
OR
OR
8/8/2019 Universal Protocol1
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Calling for a TIME OUT
Before performing theprocedure, the surgeon
or radiologist must makea declaration to theentire team
Patient¶s name is«««««««
He has consented to a««««««« whichwill be performed on the«««««(side / site).
All teammembers must agree100% with
- The patient¶s correctidentity
- The correctplanned procedure
- The correctsite of plannedprocedure
- The correct signedinformed consent for the
8/8/2019 Universal Protocol1
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Calling for a TIME OUT
The following must certify that a Time Outwas declared by signing the time out
section of the checklist1. The patient¶s anesthesiologist or surgeon or radiologist
AND2. The circulating nurse or radiologictechnologist.
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 19/29
Communication: the critical skill
targeted by the Universal Protocol
SEE IT!
Be alert to anything that feels or appears wrong
SAY IT! SPEAK UP without deference to authority or
seniority.
FIX IT!
Stop, ascertain patient¶s identity, the procedure heconsented to and which site.
All members of the team must agree 100% beforegoing ahead with procedure.
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 20/29
8/8/2019 Universal Protocol1
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Now let¶s practice
We need 10 volunteers for scenario 1
A patient
A surgeon An anesthesiologist
A nurse in charge
A transport staff
A PARU nurse
A circulating nurse
3 evaluators who will assess effectiveness of
execution of Universal Protocol
8/8/2019 Universal Protocol1
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Scenario 1 (role playing time: 5 min)
Patient is diabetic and is being treated for
sepsis and gangrenous foot (left). He is
due for amputation of the foot below theknee.
Act out the Universal Protocol at the
following scenes: Scene 1: the Nursing Floor
Scene 2: PARU
Scene 3: the Operating Theater.
8/8/2019 Universal Protocol1
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Scenario 1 (group processing time:10 min)
At end of simulation, evaluators and restof audience must rate effectiveness of
team members in complying with theUniversal Protocol.
In which of the 3 scenes is relay of patientinformation problematic? Why?
Which parts of the Protocol arechallenging to execute? What systemchanges are needed to address these
challenges?
8/8/2019 Universal Protocol1
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Shall we practice some more?
We need 9 volunteers for scenario 2
A patient
A radiology consultant A radio resident
A receiving clerk
A radio tech
A radio nurse
3 evaluators who will assess effectiveness of execution of Universal Protocol
8/8/2019 Universal Protocol1
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Scenario 2 (role playing time: 5 min)
Patient (not admitted) has multiple colloid
adenomatous goiter and is being referred
for ultrasound guided biopsy of the rightlobe.
Act out the Universal Protocol at the
following scenes: Scene 1: the Radiology Reception Area
Scene 2: the Radiology Procedure Room.
8/8/2019 Universal Protocol1
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Scenario 2 (group processing time:10 min)
At end of simulation, evaluators and restof audience must rate effectiveness of
team members in complying with theUniversal Protocol.
In which of the 3 scenes is relay of patientinformation problematic? Why?
Which parts of the Protocol arechallenging to execute? What systemchanges are needed to address these
challenges?
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 27/29
8/8/2019 Universal Protocol1
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The 3 components of the
Universal Protocol
Successful relay of patientinformation begins and ends
with team work.Teamwork is critical in
Preoperative verification
Marking the operative site Time out just before
performing the procedure
8/8/2019 Universal Protocol1
http://slidepdf.com/reader/full/universal-protocol1 29/29
Communication: the critical skill
targeted by the Universal Protocol
SEE IT!
Be alert to anything that feels or appears wrong
SAY IT! SPEAK UP without deference to authority or
seniority.
FIX IT!
Stop, ascertain patient¶s identity, the procedure heconsented to and which site.
All members of the team must agree 100% beforegoing ahead with procedure.