British Society for Dermatological Surgery

DS01 Proposal for National Dermatology Surgery Safety Standards: development of a dermatology surgery standard operating policy with mandatory training of staff may be an important tool to prevent wrong-site surgery R. Bhutani, C. Machin, G. Stables, V. Goulden and A. Mitra Chapel Allerton Hospital, Leeds, U.K. Wrong-site surgery (WSS) is the second most common reported adverse event, and accounts for 20% of National Health Service dermatology legal claims. WSS is more of a risk in dermatology because of the difficulties in identifying skin biopsy sites, including variance of individual documentation; time lag between initial consultation and surgical procedure, often by different clinicians; and multiple lesions in close proximity confounded by background secondary changes. It has been shown that up to one-third of dermatology patients are unable accurately to identify their own initial skin biopsy site. We reported two cases of WSS in 2012 at our centre, where 5200 local-anaesthetic skin surgeries are performed per year. Our initial written local surgical standard operating procedure (SOP) was produced in 2013 with introduction of a surgical checklist and the development of triplicate carbon copies of a combined surgery/photography booking form, which included large body maps to facilitate transmission of correct site identification and documentation across all multiprocedural teams. Despite this we experienced two further cases of WSS in 2014. We present the subsequent procedural changes made through our clinical governance processes to prevent further WSS and improve our patient safety and quality standards. This includes the introduction of a ‘double check policy for lesion marking’, where photographers are instructed to send patients back to the clinician if the site is not properly marked with an arrow. Use of a mirror is mandatory to reconfirm the site with the patient prior to photography and surgery, and there is a final ‘surgical pause’ where the assistant calls out and reconfirms the site and procedure with the patient and surgeon. Human factor training is being organized. Our trust has now mandated annual training in our SOP for all multidisciplinary staff involved. Specific educational intervention using a training session has been associated with reduction in WSS in a dental outpatient setting. Following our first training in 2015, improvement in lesion marking was demonstrated from a photography audit. We have also developed an interactive, scenario based e-learning dermatology SOP module to ensure that training is updated and maintained in a robust manner. This will also generate measurable evaluation outcomes that can be linked to appraisals. In 2015 National Safety Standards for Interventional Procedures were produced, but these are not specific to dermatology. We propose that our speciality produces National Safety Standards for Dermatology Surgery with standardization of local SOPs and consideration of mandatory SOP training, which could reduce WSS and deliver a safer consistent patient service across the U.K.