NASS Sign, Mark & X-ray (SMaX) Campaign Tool Update: Checklist for Safety
Gene Tekmyster, DO, MBA
Chair, NASS Patient Safety Committee USC Spine Center Los Angeles, CA
Steven Hwang, MD
Director, NASS Evidence Analysis & Research Council Shriner's Children's Philadelphia Philadelphia, PA
Wrong-site surgery (WSS) is a known risk of spine surgery due to the nature of the anatomy, transitional anatomy and distortion of landmarks from prior surgery or deformity. Wrong-site procedures (ie, spine injections/interventional procedures) have also been reported. Since 2001, the North American Spine Society (NASS) Sign, Mark and X-ray (SMaX) campaign has raised awareness of wrong-site surgery and procedures in spine care, emphasizing prevention of wrong-site surgery.
Extensive efforts have been made to address wrong-site surgery by a variety of professional, regulatory and quality organizations. The accompanying checklist serves as a guide for clinicians on appropriate steps needed to help avoid WSS and is an update to the 2014 version.
Recommendations for implementing:
- Post checklist in the operating room in a highly visible area.
- If there are multiple procedures, the checklist should be applied for each procedure.
- Consider a second time out when there is a change of surgeons/proceduralists during the case or for localization during higher risk cases.
- Do not skip steps. If any of the activities to verify patient, site or procedure fails, do not proceed until confirmation or accurate identification is obtained.
For additional resources related to this campaign, visit NASS’ SMaX Campaign page at https://www.spine.org/Research-Clinical-Care/Patient-Safety/Sign-Mark-X-ray.
Disclaimer
This material is made available for educational purposes only. It is not intended to represent the only, nor necessarily best, method or procedure appropriate for the medical situations discussed; rather it is intended to present an approach, view, statement or opinion of the authors which may be helpful. This document should not be construed as including all proper methods of wrong-site surgery prevention or excluding other acceptable methods reasonably directed to obtaining the same results. The ultimate judgment regarding any specific method is to be made by the physician in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution. The authors disclaim any and all liability for injury or other damages resulting to any individual and for all claims that may arise out of the use of techniques discussed.
Acknowledgments
The NASS Patient Safety Committee discussed the importance of updating this checklist in the Spring of 2023, following publication of the 2023 addendum to the campaign. Committee chair, GT, initiated and led this project alongside ex-officio member and outgoing chair, Thomas Mauri, MD, and Evidence Analysis & Research Council Director, Steve Hwang, MD. Following further revisions recommended by NASS’ 2023-24 Executive Committee, the checklist underwent review and approval by the Patient Safety Committee, Evidence Analysis & Research Council, and finally, NASS’ 2023-24 Board of Directors in the Fall of 2024 prior to submission.