site marking

Hello operating room nurses where-ever you are! Just a note to get your opinions (and probably open a real can of worms) :)

The subject: Site marking.

Probably everyone is familure with the new rules and regs out about marking a site, when the question of laterality is involved.

For example, marking the left wrist for a left carpal tunnel decompression.

At my hospital, we have been on board with this for some time, but today my supervisor says we need to go further. That is marking sides for like right ureteroscopies and the like. This issue is getting more complicated all the time!

I want on record as saying making sure we are doing the correct side and the correct pt is absolutely critical, and the more we do to make sure we are right, is ok with me. But, how do "y'all" feel about this, and how do you site mark right now??

Wishing I had something really cool and thought provoking to end with.

Mike

Aw, Mike, you are cool and thought provoking just as you are!!

If you go on http://www.aorn.org, you will see the guidelines about site marking--I think most places do a big "X" with indelible black marker as close to the incision site as possible on the affected extremity.

We (the holding room nurses, not OR nurses) mark the site with a great big YES in black indellible marker in the holding room. Which is then confirmed again with the circulator prior to going to the OR verbally with the patient. Then when we prep we are careful not to completely erase the mark, then when at least one surgeon is in the room after the patient is draped we call a TIME OUT where everyone agrees to the surgical procedure, the name of the patient and the site. The time out is written down in two separate areas, the op record and the site verification record, which is signed by the holding room nurse, the attending, the circulator, and anethesia. I personally think it is over the top at our institution but whatever makes everyone feel better is okay with me. The doctors make a lot of fun of it, especially when we are fixing something like broken bones, where it's very cleat by the splint and swollen fingers, what the heck we are doing to what extremity.

As far at ureteroscopies, we do not mark it, where would you mark it, thigh, abdomen, back? Also, I've been in uro cases where their is intent is to do one side but once they are in they scope the other ureter as well. I'm not about to stop a surgeon from doing what he deems as medically necessary because the op permit said one side (especially when their is one entrance to two areas). Also, in parathyroid surgery you can have the same thing. They go after the left parathyroids, but then when the PTH levels come back interoperatively it turns out the parathyroids on the other side are causing the problem so you have to go to the other side.

Common sense needs to be used in some cases. For most cases, the time out system works fine.