Amputee woman: how can the medical procedure not work the wrong way?

Before starting the operation, with the patient in the operating room and the entire medical team, the surgeon must review the procedure out loud. This detail includes something as fundamental as the place where the operation will unfold in the body. With this, which is a safety measure in the world, one of the most serious mistakes of medical practice is avoided: operating on the wrong side, as happened to a
Magdalena Leguizamón, 66, in a clinic in the city of Berazategui in Buenos Aires.

"It's the model of malpractice because it can be absolutely avoidable to take a break before starting the procedure, in which the surgeon explains to the team what she's going to do and which side she will do, "said Roberto Battelini, honorary chief of the cardiovascular surgery department of the Italian hospital.

But before arriving in the operating room, other measures must be taken, including preoperative consent and mandatory informed consent. "It's been one of the pillars of bioethics for years and every institution has to implement it," said the specialist. "The surgeon or a member of the intervening team explains the surgery to the patient and specifies the side to operate. This is before entering the operating room, except in case of emergency. The patient signs the authorization before receiving the pre-anesthetic sedatives. "

In 2011, the National Quality Forum (NQF) of the United States has defined and unveiled a group of events that should never occur as part of an erroneously integrated side surgery, site or procedure. of patient. In this country, about 4000 of these adverse events are reported during care per year.

The risks

"Care processes have risks and barriers need to be put in place to minimize them, they can not be 100% avoided, so we need to have control mechanisms in place. The entire health sector must take to provide safe care and minimize errors or risks, "said Marcelo Pellizzari, Director of Quality and Patient Safety at the Southern University Hospital (HUA) ), which is one of three certified centers in the country
International Joint Commission, which accredits more than 1,200 aspects of care processes to reduce the badociated risks.

In our country, there is no epidemiological surveillance data for this type of adverse effects during care. The only local study dates from 2007-2008, in the public system, but was only known in 2017,
as published by LA NACION.

The so-called Ibero-American adverse events study (Ibeas) on hospital care safety found that 10% of inpatients in the region had one or more adverse events during care, compared to 12.1%. % in Argentina. In addition, the risk doubles in case of prolongation of the hospitalization. The wrong side surgery is part of this preventable damage. And they occur when a patient safety program is not implemented.

On the National Quality Assurance Program web page, a checklist approved in 2012 appears last year and will be updated in the coming months, according to Mariela Barani, Director national quality of services. Health and sanitary regulations of the Ministry of Health of the country.

"It is very important to have the notification of adverse events in the care and we still have not," acknowledged the manager. And he said that next year will start to be implemented. "It is necessary to report these events so that they do not continue and that they change the culture of lack of data," he added.

Control List

The checklist or checklist, which can be viewed
here, this includes a check before inducing anesthesia that will be performed, in addition to clearing it out clearly to avoid mistakes. It is checked again before operating and bringing the patient into the recovery room under anesthesia.

"Today, health care is complex and that is why it is very necessary to implement safety programs in health facilities.The secondary error can be avoided with a measure that costs nothing and that is the checklist of surgery, which pbades twice if the place is right, "said Mariana Flichman, specialist in internal medicine and forensic medicine.

This check has three times: on admission, during the surgical break (before the incision) and before the patient leaves the operating room. "If this is fulfilled, as stated in the protocol of the World Health Organization (WHO), the patient's identity, the reason for the operation and the side to deal with open questions (other than by themselves or not) out loud, among other important aspects of surgery, such as fasting and allergies, "said Flichman.

This WHO policy has reduced by one third the morbidity and mortality badociated with surgery.

However, this type of error still occurs. "This is unfortunately something that does not surprise those who work to improve the quality of care and patient safety.The event is very small, but they exist worldwide.And for the patient, it happens 100%, "says Pellizzari.

He agreed with the rest of the specialists consulted on the importance of the application of the checklist. "The best internationally recommended practice for getting the surgery right is marking where to operate with patient compliance," added the specialist. "Lateral error occurs when the surgery has a laterality, such as eyes, kidneys, lungs, arms or legs, which are two and the side can be confused." Marking prevents confusion of the site. "

Flichman reminded, like Battelini, that the checklists had been implemented with the aviation safety model. And he said that "they manage to prevent many incidents" in the care.

"It is important that patients are aware of these programs and that they can actively participate in the safety of their care," said the doctor, who is also responsible for the risks and medical quality at Swiss Medical Group.

Berazategui

The operation of Magdalena Leguizamón took place in the new sanatorium of Berazategui. Yesterday, as we know, his family filed a complaint against the surgeon and the clinic, in addition to meeting the PAMI local authorities, the social work to which the patient is affiliated and who has the sanatorium among its providers.

The reason for the amputation of the left leg was a complication of diabetes. Last week, his daughters told the media that they had amputated a toe. But then he was instructed for a major operation. It was the same surgeon from the first intervention who operated this second time on the wrong side, according to the story of Claudia, one of the girls. During the investigation, PAMI transferred the patient last night to the Ceni Clinic in Quilmes, where measures are being evaluated to preserve the affected leg.

The sanatorium issued an unsigned statement stating that it "was available" for bodies that had requested information about the case under investigation.

Meanwhile, PAMI announced a few moments ago in a statement preemptively suspended "all scheduled traumatic surgeries" of members and that "will return patients badigned to other services operating in the region". For more information, call toll free 0800-222-7264.