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Difficulty: Very hardAccident, Error, and Injury Prevention

A practical nurse (PN) is conducting a preoperative checklist for a client scheduled for a left below-the-knee amputation. The client has a peripheral intravenous (IV) line and received a prescribed sedative 30 minutes ago, but is currently becoming restless on the transport stretcher. The PN verifies that the signed informed consent form specifies a 'left below-the-knee amputation.' However, upon physical assessment, the PN observes the surgeon's initials marked in permanent ink on the client's right leg. Which action is the priority for the PN to prevent a sentinel event?

  1. A
    Wash off the incorrect marking and use a surgical marker to initial the left leg as indicated by the consent form.
  2. B
    Administer a prescribed as-needed (PRN) intravenous (IV) push anxiolytic to manage the client's restlessness.
  3. Halt the preoperative process immediately and directly notify the surgeon of the site marking discrepancy.Answer
  4. D
    Arouse the client to have them verbally confirm the correct surgical side before proceeding with the transport.

Answer

The PN must immediately halt the preoperative process and directly notify the surgeon of the site marking discrepancy.
Preventing wrong-site surgery is a critical safety priority. According to universal protocols, any discrepancy between the informed consent, the client's physical site marking, or the medical record requires an immediate halt to all preoperative procedures. The discrepancy must be reported directly to the surgeon, who is legally responsible for resolving the conflict and personally marking the correct site before any further action is taken.

Step-by-Step Solution

1
Identify the critical safety discrepancy between the legal consent document (left leg) and the physical site marking (right leg).
Recognition of an imminent sentinel event (potential wrong-site surgery).
The Universal Protocol requires exact agreement between the consent, site markings, and client records prior to any surgical procedure.
2
Evaluate the client's current cognitive state and the PN's scope of practice.
Determination that the client cannot self-verify due to sedation, and the PN cannot alter surgical markings or administer IV push medications.
Sedated clients cannot participate in a valid clinical time-out, and site marking is strictly the responsibility of the proceduralist.
3
Execute the priority safety intervention.
The transport is halted and the surgeon is notified.
A critical discrepancy requires an immediate hard stop to the preoperative process until the primary surgeon resolves the conflict.

Key Concept

Universal Protocol and Wrong-Site Surgery Prevention
Estimated Time:1m 30s
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Topics

Accident, Error, and Injury Prevention

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