Today, we continue looking at the standard of care for avoiding wrong-site surgeries. The first step is to establish a pre-operative verification process.
The second step in the Joint Commission Universal Protocol is to mark the spot for surgery in such a way that the mark is visible after the patient has been prepped and draped. For example, if a patient is having surgery on his right knee, there must be some visible mark on the right knee to note that it is the proper site for the surgery.
Perhaps the most important part of this protocol is the specification of when it is performed. The protocol specifies that the mark should be made before the patient is taken into the surgical room. The mark should also be made with the participation of the patient (who is usually well informed about the procedure to be informed) so it should be done before any pre-op anesthesia is given. If the patient is unable to participate, then the surgeon should seek participation from someone close to the patient that is familiar with the procedure. This participation by the patient is one of the most effective ways, in many surgeries, to make sure the right procedure is performed.
The protocol specifies that the mark must be clear. A surgeon shouldn’t use something ambiguous like an “X,” which might also mean “don’t do the surgery here.” The mark should also be placed by the surgeon (and not delegated — though the rule does allow for that possibility), and the mark must be placed in such a way that it will remain in tact after the skin is prepped for the surgery.
There are some exceptions to the marking rule. A surgeon doesn’t have to mark a site that is a single organ site (for example, a c-section). And dentists are excused from the marking requirement since there is no effective way to mark teeth. However, dentists must take some precautions to make sure that the proper procedure is being performed.
Tomorrow we’ll take a look at the third and final element of the protocol.