Introduction to the Operating Room
LESSON 2: Operating Room Personnel, Policies, and Nomenclature
2-24
2-24. POTENTIAL LEGAL INVOLVEMENTS
a. Loss of Sponges. Loss of sponges is a frequent cause of lawsuits. In a few states, the responsibility for accounting for all sponges before closure rests with the surgeon. However, the law in most states is that each member of the surgical team is responsible for his specific duties. Therefore, in a case where the surgeon has performed correctly but a sponge is left in the incision, the circulator or scrub may be held responsible.
b. Burns. Burns are another frequent cause of lawsuits. A burn may occur from the use of a hot instrument such as a mouth gag or a heavy retractor. The scrub should have available a basin of cold saline solution for cooling instruments and should cool the instruments when necessary before handing them to the surgeon. A burn may also occur from a light, a thermal blanket, or an electro surgical inactive electrode.
c. Falling. Falls are another frequent cause of lawsuits. Observe the usual safeguards for children or disoriented or sedated persons, whether in wheelchairs, in bed, or on the operating table. Use special care when patients are moved from bed to table and back to bed again, as well as those being moved about on litters or wheelchairs.
d. Patient Identity. Many serious situations may arise in the hospital as the result of carelessness in checking patient identity. The right medication or treatment for the wrong patient may or may not be serious, but sometimes takes on great proportions. Be sure of the patient's identity.
e. Unconscious Patients. Since a great number of patients in the ORreceive a general anesthetic and are therefore unconscious, great vigilance is needed. If the patient is injured while unconscious, negligence may be presumed, which may require those caring for the patient to show that due care was followed during the entire period of unconsciousness.
f. Aseptic Technique. Each person on the surgical team must take the utmost care to carry out strict asepsis. Dust control, proper cleaning of floors and furniture, and sterilization of instruments and equipment are essential, along with scrub, mask, glove, and gown technique. Any break in asepsis at any point nullifies all the care taken in other ways.
g. Drugs. The same strict rules observed on the ward in regard to drugs must be practiced in the OR. The scrub frequently has dangerous drugs such as phenol or cocaine on his table. Special care must be taken to ensure that these are not used improperly. Each drug used is checked by two persons as it is prepared, and the scrub repeats the name of the drug to the surgeon as it is handed to him.
h. Abandonment. A patient left alone or a child unguarded may injure himself by an electric shock, burns, drugs, lacerations, falls, or a variety of other things. The sources of such injuries should be removed whenever possible and a patient who might injure himself carefully watched.
i. Explosions. Great care must be taken in the OR to prevent explosions.
j. Tissue Specimens. The loss of a biopsy specimen could mean the possibility of a second surgical procedure to obtain another. Improperly labeled specimens could mean a mistaken diagnosis, with possible critical involvement for two patients. The loss of a specimen could be vital if diagnosis is not made and proper treatment not given. A report from pathology on a specimen is a permanent record on the patient's chart that a certain piece of tissue or a stone has been removed.
k. Foreign Bodies. Care for these according to local policy. They often have legal significance outside the hospital, and frequently are claimed by civilian or military police. A receipt should be required of anyone taking them.
l. Consent for Operation. As a rule, witnessed written consent for an operation or procedure is signed by the patient before the surgery or procedure is performed. The patient must understand the details of the agreement fully. If the patient is a minor, unconscious, incompetent, or intoxicated, the nearest of kin or
some other authorized person must sign. If a true emergency exists and no one else is available to sign the consent, the Judge Advocate's Office should be contacted. When this is not possible, the hospital administration may give permission for the procedure or surgery.
m. Right to Privacy. This right exists either by law or by custom. Hospital charts and records, X-rays, and photographs are for use by the surgeon and other hospital personnel who are directly concerned with that patient's care. Suits can be, and have been, brought by patients for violation of this right. Unauthorized persons are not permitted to observe operative procedures. Suits have been brought by patients when unauthorized persons, out of curiosity, have been permitted to witness procedures of interest only to professional persons.
n. Confidential Information. You have a moral and legal obligation to hold in confidence any information gained from the patient during medical care. However, as there is no medical privilege in the military, you may be required to divulge confidential information upon request by proper authority.
o. Personal Property. Generally, the patient comes to the OR without any personal property. However, you should check to make sure that the patient has no eyeglasses, dentures, contact lenses, watches, wigs, or glass eyes that should be removed before surgery. Be sure to follow locally prescribed procedure in handling these articles. Be sure to obtain a receipt for any such articles when they are given to ward personnel for safekeeping. A patient who has hair clipped owns the hair that is removed, and you are responsible for its safekeeping also.
p. Records. Inaccurate record can be a source of legal action against the person responsible.
q. Defective Equipment. Operating room specialists are responsible for certain equipment checks. Any defect that was noticeable and remained unrepaired has legal connotations in case of an accident. Be sure you can prove that equipment defects were properly reported.
