Current through Reg. 50, No. 187; September 24, 2024
The Board of Osteopathic Medicine interprets the standard of
care requirement of Section
459.015(1)(z),
F.S., and the delegation of duties restrictions of Section
459.015(1)(aa),
F.S., with regard to surgery as follows:
(1) The ultimate responsibility for
diagnosing and treating medical and surgical problems is that of the licensed
allopathic or osteopathic physician who is to perform the surgery. In addition,
it is the responsibility of the treating physician or an equivalently trained
allopathic or osteopathic physician practicing within a Board approved
postgraduate training program to explain the procedure to and obtain the
informed consent of the patient. It is not necessary, however, that the
operating surgeon obtain or witness the signature of the patient on the written
form evidencing informed consent.
(2) This rule is intended to prevent wrong
site, wrong side, wrong patient and wrong surgeries/procedures by requiring the
team to pause prior to the initiation of the surgery/procedure to confirm the
side, site, patient identity, and surgery/procedure.
(a) Definition of Surgery/Procedure. As used
herein, "surgery/procedure" means the removal, incision or curettage of tissue
or an organ, insertion of natural or artificial implants, electro-convulsive
therapy, endoscopic procedure, or other procedure requiring the administration
of anesthesia or an anesthetic agent. Minor surgeries/procedures such as
excision of skin lesions, moles, warts, cysts, lipomas and repair of
lacerations or surgery limited to the skin and subcutaneous tissue performed
under topical or local anesthesia not involving drug-induced alteration of
consciousness other than minimal pre-operative tranquilization of the patient
are exempt from the following requirements. Paracentesis, thoracentesis, ocular
surgery, liposuction, lipoplasty, and Mohs, are not minor
surgeries/procedures.
(b) Except in
life-threatening emergencies requiring immediate resuscitative measures, once
the patient has been prepared for the elective surgery/procedure and the team
has been gathered in the surgery/procedure room and immediately prior to the
initiation of any procedure, the surgery/procedure team will pause and the
physician(s) performing the procedure will verbally confirm the patient's
identification, the intended procedure and the correct surgical/procedure site.
The physician performing the surgery/procedure shall not make any incision or
perform any surgery or procedure prior to performing this required
confirmation. If the surgery/procedure is performed in a facility licensed
pursuant to Chapter 395, F.S., or a Level II or III surgery/procedure is
performed in an office surgery setting, the physician(s) performing the
procedure and another Florida licensed health care practitioner shall verbally
and simultaneously confirm the patient's identification, the intended
surgery/procedure and the correct surgical/procedure site prior to making any
incision or initiating the procedure. The notes of the surgery/procedure shall
specifically reflect when this confirmation procedure was completed and which
personnel on the surgical team confirmed each item.
(c) Confirmation of the patient's identity
shall be made by using two or more of the following corroborating patient
identifiers:
1. Name.
2. Assigned identification number.
3. Telephone number.
4. Date of Birth.
5. Social security number.
6. Address.
7. Photograph.
(d) The provisions of paragraph (b), shall be
applicable to anesthesia providers prior to administering anesthesia or
anesthetic agents, or performing regional blocks at any time both within or
outside a surgery setting.
(e) At
any time after the pause is completed, but before the procedure is initiated,
if the physician(s) leave(s) the room where the procedure is being performed,
upon his or her return, the pause set forth in paragraph (b), above, must be
performed again.
(3)
Management of postsurgical care is the responsibility of the operating
surgeon.
(4) The operating surgeon
can delegate discretionary postoperative activities to equivalently trained
licensed allopathic or osteopathic physician practicing within Board approved
postgraduate training programs. Delegation to any health care practitioner is
permitted only if the other practitioner is supervised by the operating surgeon
or an equivalently trained licensed allopathic or osteopathic physician or a
physician practicing within a Board approved postgraduate training
program.
Rulemaking Authority 459.005, 459.015(1)(z) FS. Law
Implemented 459.015(1)(x), (z), (aa)
FS.
New 10-16-01, Amended 4-5-05, 11-5-07, Amended
10-3-13.
