The “Universal Protocol” (UP) was launched as a regulatory compliance standard by the Joint Commission on 1st July 1 2004, with the primary intent of reducing the occurrence of wrong-site and wrong-patient surgery. As we’re heading into the tenth year of the UP implementation in the United States, it is time for critical assessment of the protocol’s impact on patient safety related to the incidence of preventable never-events. This article opens the debate on the potential shortcomings and pitfalls of the UP, and provides recommendations on how to circumvent specific inherent vulnerabilities of this widely established patient safety protocol

The need to demonstrate probity and fair market competition has increased scrutiny of the relationships between orthopaedic surgeons and the industry that supplies them with their tools and devices. Investigations and judgements from the US Department of Justice and the introduction of the AdvaMed and Eucomed codes have defined new boundaries for interactions between these groups. This article summarises the current interplay between orthopaedic surgeons and industry, and provides recommendations for the future