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Lap Burn.
Ball K. AHRQ WebM&M [serial online]. October 2004.
While repositioning the trocar, a surgeon places the laparoscope on a tray sitting on the patient. When she picks it back up, she notices that the drape has melted and the patient has a second-degree burn.
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Resource Type
Commentary
Setting of Care
Operating Room
Target Audience
Physicians
Engineers
Clinical Area
Gynecology
Surgery
Safety Target
Device-related Complications
Intraoperative Complications
Error Types
Noncognitive Errors ("Slips & Lapses")
Approach to Improving Safety
Medical Device Design
Origin/Sponsor
Agency for Healthcare Research and Quality (AHRQ)