[RNin92]

Just a question to pose...
In my hospital we have a new policy on Site Verification.
You know..."lop off THIS necrotic leg not the good one"
New JCAHO safety goals and all...

But most places that we recently polled do things a bit differently than we do. We have to site mark everyone who has an invasive procedure unless it is an emergent case (this being the ER and all??!!??).

So tension pneumo-no marking needed
Your run-of-the-mill pneumo that is stable...mark the site

But here's the deal...
LPs???
Exactly how many lumbar spines does a person have?

And...
Who does the marking?
Most places the physician explains the procedure, consents the patient and together the site is marked
Not us...the RNs do it all...including the site marking.

How do you do it in your ER?

[traumaRUs]

I work in the ER too and we do mark the LP sites (or rather the MD's do).

[rjflyn]

Work ED as a traveler now and 16 plus years total and have never marked an LP site. As far as I know sites for surgery gets handled in the preop area of the OR. Course its generally not hard to figure out the leg that needs surgery is the one with the splint on it. We do the time out thing though-- this is Ms Smith and were doing an LP on Ms Smith.

Rj

[Dixielee]

It seems that marking an LP site is sort of like marking for an appy or chole....how may choices do you have??

I have never had to mark a site in the ER. I guess usually it is pretty obvious....uhhh, fix the ankle that is at right angles to the rest of the leg, and has the bone sticking out of it! Sew up the arm that has the blood dripping out of the pressure dressing!

[chip193]

We don't mark LPs in our ER. We don't mark chest tubes. We don't mark central lines. We don't mark much in the ER!

We do have a surgical checklist before sending a patient to the OR - and the surgeon and patient mark the surgical site.

Chip

[stevierae]

Originally Posted by RNin92

Just a question to pose...
In my hospital we have a new policy on Site Verification.
You know..."lop off THIS necrotic leg not the good one"
New JCAHO safety goals and all...

Or, "Lop off THIS necrotic leg instead of the OTHER necrotic leg, that's probably going to need it anyway, if not now, in a week or so...."

I shouldn't laugh.....that has actually happened. Not at my hospital, but in a hospital in San Jose, where I used to live. It's probably happened lots of places.

At the time, there was coincidentally a cartoon in New Yorker that had a surgeon, standing by the bedside, saying to his legless patient, "Go ahead and sue me. You don't have a leg to stand on."

LOL, that cartoon was copied and stuck up wherever you went, with snide handwritten comments about that San Jose hospital and that surgeon.

[candyndel]

We also recently adopted JCAHO's Universal Protocol which requires several procedures to assure right patient, right side, right site, right procedure. We are supposed to be marking the level of the procedure (lumbar, in this case), but it's happening slowly. The surgeon (or person performing the invasive procedure) is supposed to be marking the site with their initials. And then we all do the Time Out....