January 2022 • Volume 16, No. 1

From the Editor

As this issue goes to press, COVID-19 infection rates appear to be receding in many parts of the U.S., although hospitalization rates are expected to remain high for a while. Yes, we’re all wary of the constant barrage of coronavirus statistics in the news and what they may or may not mean, but if there is even a glimmer of hope for a less-infectious future in the near term, I’ll take it.

In this issue we take a look at wrong-site surgeries. The fact that this problem is relatively uncommon is one of the reasons it doesn’t get focused upon very often. But even though the Joint Commission’s Universal Protocol requesting time-outs before surgical procedures has been in use for nearly 20 years, a wrong-site surgery is estimated to happen once in every 100,000 surgeries, which translates to more than 100 times per year in the U.S. This includes everything from the wrong hip replaced or the wrong kidney removed to the wrong eye treated or the wrong spinal level operated on. We’ll look at some current coverage about why these errors are still happening and ways to prevent them.

Our Graduate in the Spotlight is Christine “Nicky” Hurry, BSN, CNOR, of La Prata, MD.

Scroll down for jobs we’ve collected for you and NIFA’s favorite links.

Finally, in these jangled times—hang in there.

Julie Lancaster, Editor

Wrong-site surgeries

Current Efforts Toward Eliminating Wrong-site Surgeries

In 1998, the American Academy of Orthopaedic Surgeons launched a “Sign your Site” campaign, asking surgeons to mark and sign the correct site on a patient before surgery.

That approach was incorporated in 2004 into a more detailed procedure: the Joint Commission’s Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. The Universal Protocol asks surgical teams to follow a checklist that includes a pre-procedure verification process, the marking of the site, and a time-out, to confirm patient identity, correct site, and the procedure to be done, to be conducted by the surgical team immediately before the procedure.

These practices helped put a dent in the number of wrong-site surgeries, but did not stop them. In 2009, the Joint Commission engaged a group of hospitals and ambulatory surgery centers to conduct root-cause analyses of wrong-site surgeries and near misses, then used the insights gained to recommend procedural changes in a variety of areas. Those were published in a 2014 report, Reducing the Risks of Wrong-Site Surgery: Safety Practices from The Joint Commission Center for Transforming Healthcare Project.

MDs Doing Wrong-site Surgery: Why Is It Still Happening?

In a recent Medscape article, Leigh Page discusses wrong-site surgeries and malpractice repercussions. Did you know that two-thirds of surgeons who perform wrong-site surgeries are experienced surgeons in their 40s and 50s, not beginners? And it’s not just surgeons; other OR team members can make these mistakes. Many people have difficulty distinguishing right from left, especially when the patient is turned from supine to prone position. Some surgical team members are resistant to checklists and/or don’t pay attention during time-outs; as a remedy, some institutions are filming time-outs and grading OR teams on compliance. Read more . . .

Surgeons Sometimes Operate on the Wrong Body Part.
There’s an Easy Fix.

David L. Perlow, a board-certified urologist, writing in the Washington Post, makes a strong case for surgical teams to incorporate the practice of wrong-site labeling (labeling the opposite organ or body part with “no” or “wrong”) into their procedures whenever there is a risk of right/left confusion. Read more . . .


For More Effective Time-outs

Performance Improvement in Surgical Patient Care

“It is uncommon for the root cause of preventable adverse events to be attributable to an individual’s lack of clinical competence of training, impairment, or lack of concern,” writes William H. Greene, MD, FIDSA, in the AORN Journal. “The problem often lies within a system of processes or personnel interactions that create opportunities for error.” The article explores best practices in redesigning processes and systems for behavioral change. Read more . . .

Time-outs and Handoffs

In this article from ORToday, author Don Sadler digs into common obstacles to effective time-outs and best practices for ensuring that everyone on the team is on board. Read more . . .



This 4.5-min. clip from the TV show ER shows the time-out checklist—and a surgeon’s resistance to it—in action.
Watch video…

Student Spotlight: Christine “Nicky” Hurry


Student Status
Graduated from NIFA’s RNFA program in June 2021

City & State
La Prata, MD

Current Position
RNFA at MedStar St. Mary’s Hospital in Leonardtown, MD

Where did you get your RN degree?
College of Southern Maryland (ADN) & University of MD (UMSON, University of Maryland School of Nursing)

How did you come to choose perioperative nursing?
Recommended by a family RN mentor (RNFA?)

What is the most memorable moment you’ve ever seen at the table?
Extubation on bilateral rev TSA for fracture, hovermat was used on a beach chair.

What is one technique or RNFA trick you’ve learned from NIFA that you will use for life?
The idea that skills are translatable between specialties.

How do you feel having your RNFA will impact your life/career?
I have a more versatile role in an OR, and as an RN get more opportunity to scrub.

Above, left: Nicky with her boyfriend, Wesley Harris; right: with her son, Sage Faunce.

Jobs Front

Click here for the RNFA job postings we’ve collected for you this month.

NIFA – Office Hours

Monday-Thursday, 8:00am – 5:00pm
Friday, 8:00am – 4:00pm

Practice Resources

Here are several of the most-in-demand sites for our students, prospective students and grads:

MD Edge Surgery News: Specialty News and Commentaries, Videos and More
RNFA Scope of Practice by State (PDF)
ACS List of Cases that Require an Assistant at Surgery, 2020 (PDF)
Perioperative Nurse Links (state nursing boards & professional associations)
APRN Nurse Links

Disclaimer: The views expressed in this newsletter are strictly those of their respective authors and do not necessarily represent the views of NIFA. NIFA does not give any express or implied warranty as to the accuracy of statements made by our contributors and does not accept any liability for error or omission. It is the responsibility of all perioperative personnel to work within and adhere to their facility bylaws and individual scope of practice.

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