Download Sign in process before a patient receives any sedation

SEQUENTIAL STEP 3: SIGN IN
Near miss story 1
A patient was brought to the theatre reception
area without consent, site marking, identity band
and theatre care plan. The nurse left without
handing over or ensuring the care plan checks had
been done. Another nurse came back and brought
one name band only which was hand written.
Surgeons informed and suggested to consent
patient in the anaesthetic room. Surgeon made
aware that it is against trust policy and NatSSIPs
standards to consent patient in the anaesthetic
room. Consultant surgeon informed and made a
decision that the patient should be consented and
marked in the anaesthetic room.
A patient received a spinal injection on the
opposite side to which she had consented.
‘The final gatekeepers of invasive safety checks’
Headlines
ALL PATIENTS HAVING INVASIVE PROCEDURES MUST UNDERGO SIGN IN: All patients under general, regional or
local anaesthesia, or under sedation, must undergo the sign in.
SIGN IN SHOULD OCCUR PRIOR TO SEDATION OR ANAESTHESIA
A TWO PERSON CHECK: For procedures performed under general or regional anaesthesia, these should include the
anaesthetist and anaesthetic assistant. For procedures not involving an anaesthetist, the operator and an assistant
should perform the sign in.
MAKE PROVISION FOR THOSE WHO CANNOT SPEAK ENGLISH
Learning points
The care plan is an important pre- sign in check
A patient cannot undergo surgery without 2
person checks of their name (with patient and
identity band) & their consent against the
operating list.
This paperwork should be completed before
arrival in theatre and checked at sign in
The patient should be given more time to
consider the risks of surgery and should be
consented in advance
Never event story 2
SAFETY CHECKS with signature INCLUDE:
1. Anaesthetic checks: machine, monitoring, medications. Emergency equipment checks.
2. Paperwork required: Care Plan, notes, consent, drug chart, VTE risk assessment and allergy status.
3. Patient name check with patient and against the printed identity band, consent form and
operating list.
4. Consent form checks to include no abbreviations, understanding of patient, date of consent.
5. Surgical site marking if applicable to be checked with patient, consent and operating list
6. Pregnancy status/Allergies/ Infection risk/ Arrangements in case of blood loss.
7. Starvation time / aspiration risk/ Potential airway problems.
8. Availability of essential instrumentation / implants/Staff if applicable.
Key questions for writing your site own LocSIPPs
Does an interpreter need to come to the anaesthetic room to confirm
the Sign In checks if the Care Plan and consent form were done in their
presence earlier? Would a family member suffice?
Do you have printed patient identity bands as standard?
To what extent can Sign In be standardised across the trust / site /
specialties? Should there be many different forms depending on
specialty?
How should the information checked on the Care Plan, eg NBM,
pregnancy status be incorporated into Sign In?
The pain consultant reported that his usual
procedure is to examine the patient and then
announce to the theatre staff which side(s) he
will treat. It appears that in the case of
interventional pain procedures, the theatre
team’s practice was different with that
established for ‘conventional surgery’.
The pain clinic uses an amended Safer Surgery
Checklist for pain injections. The normal
process would be for the Sign in and Time out
sections of the checklist to be done in tandem
one after the other. This means that there is not
a separate check immediately before the
invasive procedure begins.
Learning points
A formal sign in process allows a safety check
prior to the patient receiving any sedation
This check should be done with 2 people
The Stop Before You Block campaign for
regional anaesthesia also helps prevent wrong
site blocks or injections
How to make your LocSSIP the standard?
Ensure all your ODPs, anaesthetic assistants and anaesthetists know
that Sign in is an essential check. Spread this via your NatSSIPs
communications
Involve patients in Sign in- make sure they understand and reassure
them that safety is the team priority
Ensure the ward nurses are educated in the process of Sign in and
that they stay until the team are happy with the checks