Confirmation of Correct Procedure (Operative Site, Side, Site Marking)

Guidelines:

• Licensed practitioner’s initials
  • OK to be resident or other licensed practitioner working with attending
    • Facility independent policies vary
  • Must be present at time out!
• Marked before procedure, with conscious patient if possible
  • If not possible, use facility policies
    • Typically, 2 licensed providers
• Must be standardized system if not anatomically possible
  • “L”“R” Stickers, ears, bands, etc
• Additional verification required for spine!
• Emergency = use steps that do not delay care if possible

Considerations:

• Cannot be “X” or “NO”
  • consistent and recognizable
• Cannot be the patient’s own markings
  • if a patient marked, must be removed
• Location must be visible after draping
  • Prep solution can dissolve ink, avoid removing surgical mark
    • Don’t skip the prep!
• “Other indicated procedures”
  • Specific verbiage wherever possible
  • Incidental findings vary
    • Drastic change in recovery/diagnosis? Wake up and come back
• Peds consented by parents
• Fertility

Nurse’s role:

• Interview patient pre-op
  • Confirm consent matches patient’s expectations and understanding
  • Witnessed appropriately
    • Not surgical team!
  • Verify exclusive marking before transport
• Maintain visibility of mark through prep and draping
• Conduct Time-out with patient consent visible and marking surgeon present
• Conduct secondary time out for spinal procedures
  • Verify imaging reflects the consented levels
  • Surgeon to read X-ray, Nurse to verify levels desired and scrutiny
    • Only providers should read X-ray

Pitfalls:

• Separate attendings must be specifically named
  • Or have own consents
• “Resident has the consent”
• Prep solution dissolves mark
• Drape covers mark
• Shaving is not a mark!

Examples:

• Tattoo completely covers surgical site
• Right sided ureteroscopy
• “Whatever it’s called”

Linchpins (Key Points):

• Consented procedure matches actual procedure which matches patient expectation