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Implementing the SAFE SITE Bundle By: Dana M. Langness, RN, BSN, MA Senior Director Perioperative Services Regions Ho

. S=Sign site with initialsI=Informed Consent

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Implementing the SAFE SITE Bundle By: Dana M. Langness, RN, BSN, MA Senior Director Perioperative Services Regions Ho

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    2. S = Sign site with initials I = Informed Consent & Verification T = Time-Out E = Effective Communication

    3. S - Sign site with initials The facility requires, AND has a designated place to document, that the provider performing the procedure marks the procedure site with their initials. Verifies patient identity, correct site and side Mark visible when patient positioned and draped Exceptions to marking: Single organ Teeth Premature infant Intervention procedures where insertion site not predetermined Procedure through orifice & not associated with laterality Provider performing procedure is in continuous physical presence from arrival for procedure to conclusion of procedure Site sensitive areas may be marked above or lateral to the site Patient refusal – must be documented

    4. The facility requires that an indelible (permanent) non-toxic marker is used to mark the procedure site. S - Sign site with initials

    5. S - Sign site with initials The facility requires, AND has a designated place to document, that multiple procedure sites are labeled in the medical record and are numbered accordingly on the procedure sites.

    6. I - Informed Consent & Verification Informed consent with patient’s medical record. Informed consent indicates laterality, including internal laterality Patient identification with two indicators. Procedure to be performed. Procedure site and laterality and/or level

    7. I - Informed Consent & Verification

    8. T - Time-Out In the OR, the surgeon is responsible for “calling for” the “time-out” prior to starting the procedure. All team members are required to stop other activities and pause for the duration of the “time-out.” Each member of the surgical/procedure team is required to give an independent, verbal confirmation. A reconciliation process is in place for any discrepancies noted during the “time out.” An additional time-out is performed if there is a disruption during the “time-out.” A briefing (hand-off) is in place for replacement staff if staff changes occur during the procedure. Anesthesia – Time-out with one other member of care team before a block is administered.

    9. T - Time-Out Level II Hard Stop Further work to begin the procedure is stopped by all members of the team. Any member calling for a hard stop is supported.

    10. T - Time-Out The person performing the procedure conducts a final visual check for the site mark immediately proceeding the procedure after patient has been draped and positioned.

    11. E - Effective Communication Pre-Operative Review: Relevant images Implants or special equipment Special patient issues Patient positioning and other pertinent information Intra-operative – implants Implant specification/type/expiration date Size Laterality Intra-operative – internal laterality Verify target site Confirm procedure to be performed

    12. E - Effective Communication

    13. E - Effective Communication

    15. Questions?

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