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reference mark loses its usefulness, and it's easy to lose your orientation when patients are moved, turned over and repositioned for surgical access.
The need for visible site marks presents a particular challenge when a site is not conducive to marking. Genitalia, for example, are difficult to mark. Inking the groin would be conveniently close, but to a booked-up surgeon, the case might be confused with a hernia repair on the schedule and the nearby mark might lead to an off-target incision. Alternatively, you could apply a special wristband or make a mark on the patient's hand, but those areas may end up covered by a drape and remain unseen during the time out.
Establishing a consistent protocol for marking sites in difficult-to-ink areas, and then visualizing them in prepped and draped fields, should be a priority for facilities specializing in general, urological, gynecological and other non-extremity surgeries. "The mark," says Dr. Clarke, "is a way to reinforce safety for the physician in the OR. This is memory refreshed, the verification with the patient."
6 Speak up
The ability to communicate openly depends on each staffer's confidence in their role in the site-marking process. Since every nurse and every tech is charged with ensuring patient safety, they should also have a hand in the progress of the surgical process. "The attitude of 'I'm the doctor, you're the nurse, do what I say,' that has to end," says Dr. Clarke. "We have to create a culture of empowerment. Every person in the process must be able to stop the whole process if they see something wrong. The patient should not go to the room unless everybody agrees."
That's why taking the pre-op time out seriously is among the most
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On the web:
Joint Commission's Universal Protocol:
tinyurl.com/775t6s2
World Health Organization's
Surgical Safety Checklist:
tinyurl.com/42g7qq
Pa. Patient Safety Authority's WrongSite Surgery Educational Tools:
tinyurl.com/qhrna98
AAOS's "Sign Your Site" Campaign:
tinyurl.com/ofc5g6a
