Confirmation of Correct Procedure (Operative Site, Side, Site Marking) for Certified Perioperative Nurse (CNOR)
Included In This Lesson
Outline
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!
- OK to be resident or other licensed practitioner working with attending
- Marked before procedure, with conscious patient if possible
- If not possible, use facility policies
- Typically, 2 licensed providers
- If not possible, use facility policies
- 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!
- Prep solution can dissolve ink, avoid removing surgical mark
- “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
Transcript
References
- Association of periOperative Registered Nurses. (2022). Guidelines for Perioperative Practice (2022 ed.).
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System