How to reduce wrong-site skin lesion excision

What is it about?

This Patient Safety Solution is recommended in dermatological surgery when the number or location of the lesions carries a risk of incorrect identification, particularly in the management of malignant lesions (squamous or basal cell carcinoma, modified or atypical naevus, malignant melanoma and Dubreuilh's melanoma). Its aim is to reduce the identified root causes of this care-related adverse event. 

This Patient Safety Solution concerns all professionals involved in plastic or dermatological surgical activities resulting in the excision of a skin lesion. This activity may be carried out in a community medicine setting or in a healthcare organisation: in an out-of-hospital, outpatient or hospital setting.

Method

The analysis of the feedback database for the doctors and medical teams accreditation system allowed the identification of 5000 declarations for plastic surgery between 2008 and 2012. Eighty-five events resulting in surgical site errors (excluding patient errors) in dermatological surgery have been extensively studied in order to determine the root causes of this risky situation.

Moreover, a literature search has been conducted by the approved accreditation body.

Risk reduction tools

The adverse events in-depth analysis allowed identification of causes and circumstances of wrong-site skin lesion excision and proposes the following solutions :

• Prevent: use of a standardized communication medium (liaison sheet in dermatological surgery), take digital photos of the lesions.
• Recover: safe management of anatomical pathology exams if the event occurs.
• Remind: best clinical practices.