[voskamp]

Hi , I am a nurse in a dutch hospital, and I have a question.
The insurance company of our hospital recently asked the hospital to mark the bodyparts before surgery, that will be operated on. This is a safety rule, a check to prevent docters to operate on the wrong bodyparts. In our country this is a new procedure.
We have some questions about this procedure, that the insurance company says, is well known in other countries.
Our biggest question is ; Who does the marking (an arrow or cross on the bodypart in question)?
The docters wont do it because they don't always have time to see the patient before theater.
The nurses won't do it because they get there information about the surgery from an informal piece of paper and not from the medical status, therefore we worry about the legal complications when we mark the wrong bodypart and mistakes are made in the operating room. The third option would be the patient, but we often experience with older patients that they are not completley sure about the surgery themselves, so they would ask us where to put the cross or arrow.
My question to you all would be; Do you have any experience with marking patients? Who does the marking? At what moment? Do you have a protocol about marking? Thank you!

[maryb]

My only experience is a personal one. I had knee surgery while stationed in Iceland, in an Icelandic hospital. The surgeon personally came in and marked my knee with a big arrow prior to surgery.
The surgeons may feel that they don't have time, but they are the ones that should know what they are operating on, in my opinion.
I've taken a consent form into a room for a patient to sign preoperatively and begun talking about the surgery only to have the patient so "wait a minute, I'm not having...." You can fill in the blank. Mistakes get made. In that case, the physicians office sent over the wrong standard forms. Who was the physician mad at? Me.
With anything new, no one ever seems to want to take responsibility, and as a group, physicians are VERY resistant to change. I hope you guys work this one out.

[voskamp]

Originally posted by maryb
My only experience is a personal one. I had knee surgery while stationed in Iceland, in an Icelandic hospital. The surgeon personally came in and marked my knee with a big arrow prior to surgery.
The surgeons may feel that they don't have time, but they are the ones that should know what they are operating on, in my opinion.
I've taken a consent form into a room for a patient to sign preoperatively and begun talking about the surgery only to have the patient so "wait a minute, I'm not having...." You can fill in the blank. Mistakes get made. In that case, the physicians office sent over the wrong standard forms. Who was the physician mad at? Me.
With anything new, no one ever seems to want to take responsibility, and as a group, physicians are VERY resistant to change. I hope you guys work this one out.

Thanks for your reply, i agree that the surgeon should mark what he/she operates on. Your exemple about that consent form shows how easely mistakes are made.

[IluvMyPtsPeriod]

SUBJECT: Patient identification and POLICY NO.___PAGE 1 OF 2
marking of surgical site.
DATE EFFECTIVE: 10/98

PURPOSE: To have the patient identify DATE REVISED:
and mark their surgical site
prior to premedication, as part APPROVED BY:
of the pre-operative assessment.
ISSUING DEPARTMENT: Surgery

APPROVED FOR USE IN: Surgery

Supportive Data: The identification and marking of the surgical site by the patient will apply to all patients capable of signing a surgical consent. For minors or patients not capable of signing their own consents, the parent or legal guardian will mark the surgical site for the patient. This procedure will promote proper identification of any surgical site that is either right or left side.

This protocol is an adjunct to obtaining a consent for an invasive surgical procedure after the procedure's risk/benefit have been explained to the patient by the surgeon. The surgical consent should be validated by checking the physician's order.

Definitions:
Marking: Using a surgipen marker to identify surgical site.
Specific site: Any surgical site that is either right or left side. (i.e.
right breast, left eye, right leg, etc.)
Preoperative: Prior to premedication and surgery, when the patient is not in
a pharmacologically mood or mind altered state.

Procedure:

1. Patient is identified in pre-op. holding area.
2. Consent is verified for accuracy and completeness by the RN checking patient
in the pre-op. area.
3. Patient identifies surgical site and if a right or left type procedure, marks
the site with a surgipen.
4. Consent is rechecked by the RN to ensure consistency.
5. If patient is a minor or not capable of identifying the surgical site, a
parent or legal guardian is permitted to identify and mark the site.
6. Surgical site is to be marked with an "X" using a surgical marking pen
(obtain pen from Central Processing).
7. If patient is a minor or not capable of identifying the surgical site and no
family members or responsible person is available, the surgeon will mark the
surgical site with an "X".
8. Patient is then pre-medicated if prescribed.