Using ACS Recommendations to Prove Standard of Care in a Foreign Object Case
posted on February 24th, 2009 by clintThe true incidence of surgeons closing a patient after surgery and mistakenly leaving foreign bodies inside the patient is not known. There have been estimates ranging from surgeons leaving foreign bodies inside patients as frequently as 1 out of 100 patients to 1 out of every 5,000 patients. Foreign objects or devices are too often left inside patients due to abject negligence. Surgical teams leave surgical sponges, pins, blades, clips, gauze, cotton or other medical instruments or hardware that do not belong inside a patient. These objects can damage to tissue, blood vessels and organs or cause life threatening infections, among other hurtful consequences.
The American College of Surgeons has issued a policy designed to prevent the problem of leaving foreign bodies inside surgical patients. In [ST-51], the American College of Surgeons noted that prevention of foreign body retention requires good communication among perioperative personnel (personnel involved with patient just before, during and after surgery – nurses, surgical technologists, anesthesia professionals and surgeons) and the consistent application of reliable and standardized processes of care.
The ACS came up with good recommendations that can be a source for standard of care principles for you in discovery:
1. Consistent application and adherence to standardized counting procedures;
2. Performance of methodical wound exploration before closure of the surgical site use of x-ray detectable items in the surgical wound
maintenance of optimal OR environment to allow focused performance of operative tasks;
3. Employment of X-ray or other technology (e.g. radiofrequency detection, bar coding) as indicated, to ensure there is no unintended items remaining in the operative field suspension of these measures as required in life threatening situations;
4. Documentation of surgical item counts with notification of surgical team members of items left intentionally and of any count discrepancies; and
5. Surgical facilities must provide resources to ensure equipment and personnel are adequate to employ these safety measures
Policies and procedures for the prevention of retained foreign bodies should be developed, reviewed periodically and revised as necessary.
These ACS recommendations are just that. However, I prefer using rules of the road as an approach to winning cases. When you have a foreign object case, these recommendations should be helpful to you and your expert.