Wrong Site Surgery Policy

Last updated: 14.03.2023

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Wrong Site Surgery Policy

Last updated 14.03.2023

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Wrong site surgery is a rare, but serious event that can have substantial consequences for patients and healthcare providers. It occurs when a surgical or invasive procedure is undertaken on the wrong body part, the wrong patient or the wrong procedure is performed.

There are several interventions to reduce surgical errors or prevent WSS, mainly involving pre-operative verification, such as the development of a universal protocol.

Examples
    • Wrong-site surgery
    • Retained instrument post-operation
    • Wrong route administration
Improving the safety of tooth extraction and other types of dental surgery begins with a highly reliable preparatory procedure. The process by which dentists typically prepare patients for dental extractions in the office setting involves the following steps:
  • Review the treatment plan (or if referred the referral slip) regarding which tooth is to be extracted
  • Review the medical history and record the vital signs
  • Perform the oral evaluation to assess the surgical site
  • Obtain written informed consent (generally, a pre-printed form with a notation of the tooth to be extracted)
  • Administer the local anaesthesia
  • Perform the procedure
  • Give postoperative instructions and dispense prescriptions as required
  • Discharge patient when stable and arrange for follow-up
Recommendations For Safe Practice
  • Develop an educational program for the entire staff on preventing wrong-site tooth extraction
  • Design a more informative referral slip
  • Inform the patient/parent/guardian verbally, and with a hand-held patient mirror, which tooth/teeth are to be extracted at the initial consultation appointment
  • Confirm that the patient, chart, and x-ray (properly oriented) are correct and confirm which tooth is to be extracted at the surgical appointment
if a wrong tooth is extracted, regardless of whether the error was identified immediately or delayed, full disclosure and possible remedies must be presented to the patient.

Approved by: Kassandra Pantazi, Jakobus Krynauw
Date published: 25/10/2021