Wrong site surgery has become a frequent incident in health care facilities across the nation. “Research in the US has suggested that wrong site surgery happens every 5-10 years, or one in 112,994 cases” (Edwards, 2008, p. 168). Recent studies have shown that despite the focus by governing bodies over wrong site surgery in the past few years, wrong site surgery continues to happen at an alarming rate of 40 times per week in the United States alone (“Wrong-site surgery still happens 40x/week”, 2011). Throughout this paper The Neighborhood newspaper article, “Amputation Mishap; Negligence”, will be discussed.
There will be a differentiation between negligence, gross negligence, and malpractice. I will make a decision regarding whether the incident referenced in the newspaper article was negligent or not. I will also describe the importance of documentation related to the incident and its correlation to potential negligence. An explanation of what ethical principles would guide my practice as a nurse in this situation and how I would document the case to satisfy ethical and legal requirements will also be discussed.
The Neighborhood newspaper article, “Amputation Mishap; Negligence”, describes an incident where a 62-year-old man had the wrong leg amputated in surgery. The man suffers from diabetes, which has led to poor circulation in his leg, requiring surgery. The man woke up after surgery to find that the wrong leg was amputated. The newspaper article also states that the hospital has been suffering from a nursing shortage and union problems.
Negligence occurs when “one may have performed or failed to perform an act that a reasonable person would or would not have done in similar circumstances” (Harrison & Judson, 2010, p. 69). While negligence is seen as a decrease in the expected standard of care, “gross negligence is seen as a complete failure to show care that in fact implies recklessness or a willful disregard for safety and human life” (“Brent Adams & Associates”, 2012, para. 3). Malpractice is often used in conjunction with the term negligence. However, the two terms are quite different.
“The concept of malpractice is often used to embrace all liability-producing conduct arising from the rendition of professional services, including, but not limited to, negligence, intentional misconduct, breaches of contracts guaranteeing a specific therapeutic result, divulgence of confidential information, unauthorized postmortem procedures, failures to prevent injuries to certain non-patients, and defamation” (Garmin Bibb & Weld, 2009, p. 4). I would not be able to agree with the statement made by The Neighborhood paper that the wrong-site surgery performed was negligent. I would need more information to come to that conclusion.
When a wrong-site surgery occurs it must be reported to joint commission. Most hospitals perform an investigation called a Root Cause Analysis. Throughout this investigation all parties involved are interviewed to get a complete understanding of what the cause of the incident may have been. Negligence may have been the cause but a system failure may have also been the cause. Several variables could have existed leading to the performance of a wrong-site surgery. Over the years health care facilities have set in place several fail safe steps to help prevent wrong-site surgeries.
Pre-operative marking of the surgical site by the surgeon, verification of surgical site, and the surgical time out should be performed. Verification of the surgical site is performed upon entering the preoperative suite, prior to the surgeon marking the site in the preoperative suite, upon assessment by the operating room nurse, and once in the surgical suite during the time out procedure prior to incision. Failure to perform any of these checks could lead to a wrong-site surgery. Documentation is extremely important in regard to invasive procedures, such as surgery.
An informed consent must be provided by the surgeon and signed by the patient. The informed consent is more than just a piece of paper with a signature on it. It states the procedure to be performed along with any possible complications that may occur. Educating the patient prior to signing the informed consent is required by law. Documentation of the surgical time-out should also be done to make sure that the entire team has an understanding and agrees with the procedure to be performed on that specific patient by a specific surgeon.
If I were part of this situation in which a patient lost the wrong limb in surgery, the ethical principles that I would follow would be that of beneficence, non-maleficence, and fidelity. By promoting good and providing the safest care for my patient, I am providing the principle of beneficence. In contrast, by doing no harm to my patient, I am providing non-maleficence. I believe that I would be providing fidelity to my patient once I provide any kind of care. As a nurse it is my job and my duty to promise and commit to doing no harm to my patient.
I believe that communication is the main reason problems occur in health care. It is crucial that the health care team works together as a team and communicates any issues or concerns throughout the process of patient care. No matter how many processes are put into place or how many checklists are followed, mistakes are going to be made unless proper communication occurs. Unfortunately, these mistakes are usually at the cost of safe patient care. According to Edwards (2008), “every member of the surgical team has a clear role to play in the promotion of safe surgery.
Correct site surgery is one type of error, but it has the potential to be one of the most devastating” (p. 170). Reference Brent Adams & Associates. (2012). Retrieved from http://www. brentadams. com/library/what-is- negligence-what-is-gross-negligence. cfm Edwards, P. (2008, April). Ensuring Correct Site Surgery. Journal of Perioperative Practice, 18(4), 168-171. Retrieved from http://ehis. ebscohost. com/eds/pdfviewer/pdfviewer? sid=d3407dac-7da0- Garmin Bibb, S. C. , & Weld, K. K. (2009, January-March).
Concept Analysis: Malpractice and Modern-Day Nursing Practice. Nursing Forum, 44(1), 2-10. Retrieved from http://ehis. ebscohost. com/eds/pdfviewer/pdfviewer? sid=cfe249bd-82e4- 4d87-a9e8-ff1b01f27fd6%40sessionmgr113&vid=14&hid=116 Harrison, C. , & Judson, K. (2010). Law & Ethics for Medical Careers (5th ed. ). New York, NY: McGraw-Hill. Wrong-site surgery still happens 40x/week. (2011, August). Healthcare Risk Management, 33(8), 91-92. Retrieved from http://ehis. ebscohost. com/eds/pdfviewer/pdfviewer? sid=cfe249bd-82e4- 4d87-a9e8-ff1b01f27fd6%40sessionmgr113&vid=3&hid=116.