delegation at St. John Macomb-Oakland Hospital, Oakland Center in
Madison Heights, Mich., says Pamela Borello-Barnett, RN, BS, CNOR,
clinical nurse manager of surgical services. "Only the surgeon marks the
site."
Concerned about pushback? "Give the policy to every new surgeon
and have them sign off that they received it," suggests Rita Young,
BScN(H), RN, unit manager at Queen Elizabeth II Hospital in Grande
Prairie, Alberta, Canada. Remember what's at stake, "adhere to your
policy and do not back down," adds Marc Chudow, RN, charge nurse
at the University of South Florida Morsani ASC in Tampa, Fla.
It may help to remind surgeons that if something goes wrong, "ulti-
mately, the licensed independent practitioner is accountable for the
procedure," says the protocol, "even when delegating site marking."
That's true in your hierarchy and it's likely to be true in court, as well.
"Educate, encourage, enforce," says Brandy Miller, MHA, MSN, RN,
CNOR, director of The Surgery Center in Fort Wayne, Ind.
Not moving
Many readers say that the best way to make sure surgeons take full
responsibility is to make a hard-and-fast rule that unmarked patients
don't enter the OR.
"Our compliance with site marking improved dramatically when we
implemented a policy that patients would not leave the holding room
until the site mark was complete," says Mary Wilson, BSN, RN, CNOR,
clinical preceptor/educator at WVU Hospitals in Morgantown, W.Va.
"We rarely have to remind surgeons to mark, now that it will delay
their OR start time."
Same goes for the Pennsylvania Eye & Ear Surgery Center in
Wyomissing, Pa., where if unmarked patients somehow make it into
the OR, surgeons "must break scrub, then mark, then rescrub," says
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