Current through Reg. 50, No. 187; September 24, 2024
The Board of Medicine interprets the standard of care
requirement of Section
458.331(1)(t),
F.S., and the delegation of duties restrictions of Section
458.331(1)(w),
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
doctor of medicine or osteopathy who is to perform the procedure. In addition,
it is the responsibility of the treating physician or an equivalently trained
doctor of medicine or osteopathy or a 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
treating physician 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 and immediately prior to the initiation of any procedure, the
team will pause and the physician(s) or physican assistant(s) performing the
procedure will verbally confirm the patient's identification, the intended
procedure and the correct surgical/procedure site. The operating physician or
physican assistant(s) 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) or physican assistant(s) performing the procedure and
another Florida licensed health care practitioner shall verbally and
simultaneously confirm the patient's identification, the intended procedure and
the correct surgical/procedure site prior to making any incision or initiating
the procedure. The medical record shall specifically reflect when this
confirmation procedure was completed and which personnel on the 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 licensed pursuant to Chapter 458, F.S.,
prior to administering anesthesia or anesthetic agents, or performing regional
blocks at any time both within or outside a surgery setting.
(e) At the time after the pause is completed,
but before the procedure is initiated, if the physician(s) or physican
assistant(s) leave(s) the room where the procedure is being performed, upon his
or her return, the pause set forth in subsection (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 doctors
of medicine or osteopathy or to physicians 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 doctor of medicine or osteopathy or a
physician practicing within a Board approved postgraduate training
program.
Rulemaking Authority
458.309,
458.331(1)(v)
FS. Law Implemented 458.331(1)(v)
FS.
New 11-28-91, Formerly 21M-20.015, 21M-27.007, 61F6-27.007,
59R-9.007, Amended 2-18-04, 9-18-05, 4-25-06, 5-6-08, 1-29-13, 1-29-13,
5-15-14.
