ince the release of the Instituteof Medicine report, To Err isHuman: Building a Safer HealthSystem,1 many individuals,groups, and health care organ-

izations have focused on improvingpatient safety. These efforts have result-ed in numerous recommendations andinterventions to reduce both active andlatent errors. The Joint Commission onAccreditation of Healthcare Organiza-tions (JCAHO) provides guidance tohealth care organizations by establish-ing National Patient Safety Goals.Issues addressed by current and pastsafety goals include patient identity,correct site surgery, hand offs, and vari-ous other processes of care.2

Despite JCAHO’s efforts and thoseof clinicians, educators, and research-ers, medical errors continue to occur.One common factor in many medicalerrors involves clinicians not knowingthe patient.3 This knowledge gap candirectly result in a wide variety oferrors including patient misidentifica-tion, wrong-site surgery, omission ofessential medications, and problemswith hand offs.

AN UNFORTUNATE SCENARIOIn this era of subspecialization,

many physicians and specialists do notserve as the primary care provider for aspecific patient. In fact, a consultationvisit can result in a surgical decision,and the next time the surgeon sees thepatient may be in the OR. Imagine a sit-uation in which a patient is admittedfor same day surgery and undergoes anelective procedure by a specialist sur-geon. During surgery, the patient expe-riences some unexpected bleeding, andthe surgeon decides to admit thepatient. The patient did not expect to behospitalized, and none of the cliniciansobtained a complete medication list

when she was admitted for surgery.The patient routinely takes digoxin foratrial fibrillation, but no one is awareshe has been taking this medication,and no orders are obtained to continueit during her hospitalization. Thepatient has prolonged hospitalization,and during her stay, she developsuncontrolled atrial fibrillation and sub-sequently, developsstroke symptoms. Thatthe patient should havebeen taking digoxin isnot discovered until herprimary care physician iscontacted. This type oferror occurs all too fre-quently, especially whenclinicians do not knowthe patient or informa-tion about the patient’songoing care.

EVERY PATIENT IS UNIQUEThe current complexi-

ty of patient care makes itincreasingly challengingto know the patient, but clinicians mustwork together to ensure that essentialinformation about each patient isobtained, recorded, and communicatedin an effective manner. Clinicians needto ask themselves, “Do I know enoughabout this patient to provide safe care?”If the answer is no, they need to taketime and assess information that maybe required to ensure patient safety.Assuming that someone else knows thepatient can create situations in whicherrors can occur because redundant systems for checking and verifyinginformation such as identity, allergies,correct site, and procedure are not avail-able. Every patient is unique and eachclinician who cares for the patient musttake time to get to know the patient andobtain accurate information about the

AORN JOURNAL • 825

Guest Editorial APRIL 2006, VOL 83, NO 4

The value of knowing the patient

G U E S T E D I T O R I A L

Suzanne C.Beyea, RN

SClinicians need toask themselves,

“Do I knowenough aboutthis patient toprovide safe

care?”

826 • AORN JOURNAL

APRIL 2006, VOL 83, NO 4 Guest Editorial

patient’s health status to en-sure the patient’s safe passagethrough an episode of care.

PERIOPERATIVE NURSES’ ROLEPerioperative RNs play an

instrumental role in establish-ing a relationship with thepatient, serving as thepatient’s advocate when thepatient cannot act for himselfor herself, and conveyingimportant information before,during, and after surgery andduring hand offs to othercaregivers, including care-givers in other clinical set-tings. When the circulatingnurse first makes contact withthe patient, the nurse mustidentify key pieces of infor-mation. These include thepatient’s identity; the plannedsurgical procedure, site, andlaterality; and the patient’swishes and desires regardinghis or her care. Wheneverpossible, the patient is the bestsource of information. Thepatient should be asked tostate his or her name and theplanned surgery and its loca-tion. The patient’s clinicalrecord should be used to con-firm this information, but thenurse should verify all perti-nent information with thepatient whenever appropriate.

Perioperative RNs play keyroles in working with othermembers of the perioperativeteam to ascertain that the cor-rect patient undergoes thecorrect surgical procedure andthat crucial information aboutthe patient is shared with theappropriate members of thehealth care team. For exam-ple, during the chart review,

the circulating nurse mightdiscover a discrepancybetween the surgical scheduleand the patient’s clinicalrecord. Rather than letting thesurgery proceed, the nurse iswell-positioned to bring thisdiscrepancy to the attention ofother members of the surgicalteam and share knowledge ofthe patient.

A CRUCIAL SAFETY INTERVENTIONConsider the scenario

described earlier duringwhich the patient’s digoxinwas inadvertently discontin-ued. Obtaining a completemedication list from thepatient on admission for sur-gery and verifying that listwith the primary care physi-cian could have made a dif-ference. If the patient’s med-ication list had been com-plete, the medication wouldhave been continued during

hospitalization, and thepatient would not have suf-fered a stroke. Taking time toget to know this patient couldhave resulted in a much bet-ter outcome.

In the current, demandingclinical environment, takingthe few extra minutes to con-verse with a patient may notalways seem like a priority.The few minutes spent gettingto know the patient, however,may be a critical nursing andsafety intervention. Withouttaking that time, crucial safetyinformation may be missedand could contribute to a seri-ous medical error. Getting toknow the patient may be themost important step in creat-ing a safer process of care.Helping other members of thehealth care team know whothe patient is and what his orher needs and concerns are isa critical nursing role. ❖

SUZANNE C. BEYEARN, PHD, FAAN

DIRECTOR OF NURSING RESEARCH

DARTMOUTH-HITCHCOCK MEDICAL CENTER

LEBANON, NH

NOTES1. L T Kohn, J M Corrigan, M SDonaldson, eds, To Err is Human:Building a Safer Health System(Washington, DC: NationalAcademy Press, 2000). 2. “National Patient Safety Goalsfor 2006,” Joint Commission onAccreditation or HealthcareOrganizations, http://www.jcaho.org/accredited+organizations/patient+safety/npsg.htm (accessed 24 Feb2006).3. R Hess, “Identity crisis,” ForThe Record 17 (Jan 17, 2005) 34.Also available at http://www.fortherecordmag.com/archives/ftr_011705p34.shtml (accessed 27 Feb 2006).

When you are busy,taking a few extraminutes to conversewith a patient maynot always seem likea priority, but thosefew minutes may bea critical nursing andsafety intervention.