By Ken Thomas,
medical negligence specialist at Harding Evans Solicitors
Last month, the National Patient Safety Agency issued a patient
safety alert regarding “correct site surgery”. These guidelines are
intended to help ensure the correct operation is performed on the
correct part of the patient’s body. Many will be mystified that
there needs to be guidance on what is so obviously a fundamental
point. However, errors of this nature do unfortunately occur.
Most people will recall the tragic case of Graham Reeves, a South
Wales man who had the wrong kidney removed in 2000. Instead of
removing the diseased kidney, surgeons removed the other (healthy)
one by mistake. Mr Reeves died shortly afterwards.
The Medical Defence Union – an organisation which represents doctors
– has analysed surgical errors. Between 1990 and 2003, it identified
119 operations where the wrong side of the patient’s body was
operated upon. The guidance issued last month is intended to avoid
or eliminate this sort of occurrence.
Prior to surgery, a surgeon will routinely mark the correct area to
be operated upon. He or she will use an indelible marker pen. The
guidance calls for consistency in this process. Up until now,
different surgeons have used different marks. This can cause
confusion for other members of the operating team.
The NPSA has worked with surgeons to agree a standard way of marking
the correct area. All NHS hospitals have been advised to use this
new system. A checklist has been produced. This states that the
surgical site should be marked before the patient is given
medication and before transfer to theatre. The patient and/or family
members should be involved wherever possible. Marking should be
undertaken by the operating surgeon or a nominated deputy.
There is also a briefing for patients. This encourages patients who
think the mark(s) may be wrongly located to tell a member of staff.
Patients are requested to be patient if medical staff ask them
several times which part of the body is to be operated upon.
It is clearly stated that emergency surgery should not be delayed
due to lack of pre-operative marking.
Errors of this nature are not confined to hospital settings. In the
MDU study, perhaps the most alarming statistic of all was the number
of mistakes made by dentists removing the wrong teeth. Such
incidents accounted for nearly half of the reported errors. Though
marking is clearly not appropriate in dentistry, those errors could
have been prevented if patient checking procedures and protocols
were consistently followed.
From a legal point of view, such fundamental mix-ups are hard to
defend. As such, they inevitably cost the NHS money and patients can
suffer significantly. The guidance issued recently must accordingly
be welcomed.
