Marking the Site Right (Correctly)

Patient Safety

By: Pamela Bevelhymer

Published: 9/23/2016

Share:

There are lots of ways to do it wrong, but only a couple of ways to do it right.


Marking the site of the surgical incision before the induction of anesthesia is the surest way to prevent wrong-site surgery, but only if it's done — many facilities have adopted a "no-mark, no-surgery" policy — and only if it's done properly. Surgical site marking is not a time for individual expression or to draw cutesy symbols and squiggly lines — those marks will only confuse the surgical team when they're confirming where to cut. Your surgeons and staff need to agree on a standardized approach and use it to mark each and every patient. Outpatient Surgery Magazine photographer Pamela Bevelhymer, RN, BSN, photographed 8 examples of site marking done correctly and some scenarios that can cause confusion and lead to errors. OSM

use initials

CRYSTAL CLEAR There are only a few simple rules to follow. First, the surgeon should use his initials (unless they're NO) or the word YES as the surgical mark. Second, place the mark as close as anatomically possible to the incision site using a single-use surgical skin marker. Third, have the surgeon mark the site before the patient enters the OR.

?
patient site-marking

INVOLVE THE PATIENT Whenever possible, involve the patient in the site-marking process. Put the marking pen directly into the patient's hand before sedation and have him mark the correct site. Otherwise, a surgeon might operate on the wrong knee if a patient points to the one that's hurting him more on the day of surgery.

site mark gets washed away

WASHED AWAY If your site mark gets washed away by pre-op skin prep solutions, it loses its usefulness. The solution: Use an indelible marker that ensures that the mark will be visible after the skin prep.

sticker above the operative eye

OPHTHALMIC SITE MARK Keep in mind that any mark placed near or around the eye may be obscured by surgical drapes and may not be visible during a pre-procedure time out. Placing a sticker above the operative eye is a good adjunct to the mark you place with a marker.

mark the operative sit\e

REVERSE ANGLE It's easy to lose your orientation when patients are moved, turned over and repositioned for surgical access. Be sure you mark the operative site in such a way as to ensure that when a patient or a limb is turned or placed in a different position, the mark is still clearly visible to the surgical team.

indicate the surgical si\te

DOES 'X' MARK THE SPOT? Do not mark non-procedure sides or sites. The use of an "X" as the surgical mark could indicate the surgical site, but could also easily be misinterpreted as a warning indicating the non-operative site.

individually mark fingers, t\oes

MULTIPLE STRUCTURES Individually mark all fingers, toes or lesions requiring surgery. Toes and fingers must be marked with specification of the digit(s). Here, the big toe and first toe are marked for surgery above the surgeon's initials.

regional anesthetic block \site

WRONG-SIDE ANESTHESIA BLOCK Wrong-site anesthetic blocks are increasingly common. There's some debate about whether you should separately mark the regional anesthetic block site. If you do mark the block site, experts say you should place the mark after the surgeon marks the surgical site, so you don't obscure the surgeon's mark. Also be sure, experts say, that the anesthetic block mark isn't visible in the prepped and draped surgical field.

?



Related Articles