Patients marking correct surgical site pre-op?

[Ligament]

Hi All,

What are your thoughts and practices in your ORs about patients marking the correct surgical site in addition to you (the surgeon) marking the correct surgical site? Is there literature to show benefit in this? Thx.

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[catnip12]

What's the point of doing that?

 

[HighPriest]

A lot of my patients can’t tell lefty from righty. I just tattoo the site in the clinic. Somethin cool, like an Eagle fighting an iguana over a bottle of Bacardi.

 

[Wordead]

That sounds like a terrible idea. Yes your honor, I operated on the wrong side because the patient told me to and I didn't review and verify my own documentation.

 

[HighPriest]

This is why, if you ever operate on the wrong side you just do the same procedure on BOTH sides. Then it’s not a wrong side surgery, it’s just extra work for FREE.

 

[Ligament]

That sounds like a terrible idea. Yes your honor, I operated on the wrong side because the patient told me to and I didn't review and verify my own documentation.

Specifically, patient marking surgical site in addition to the surgeon, not instead of...

 

[Smurfette]

1. Patients can't reach all sites to mark them.
2. Patients sometimes don't know/understand what's going on for various reasons.
3. The surgeon still needs to check and make sure the site is marked, so why make the patient do it?
4. Having the patient mark the site is unlikely IMO to change the rate of (already thankfully rare) wrong site surgery. If the patient is marked before surgery and doesn't realize it's the wrong side when marked, then the patient is also probably not reliable to mark the correct site him/herself.
5. Why would you need both? How is that beneficial?

 

[Wordead]

Specifically, patient marking surgical site in addition to the surgeon, not instead of...

Why shouldnt we have the bedside nurse do it too and maybe the patient's mother in law? More = better

 

[LucidSplash]

Half my patients don’t know what they are getting surgery for. And let’s not start talking about an angio where I access the arterial system at a site different from the limb I’m actually planning to intervene in. 😂

 

[deleted50541]

This is like when someone proposed also marking the "wrong" site for surgery. I don't think it caught on and there was a lot of backlash over creating unnecessary confusion.

I do a lot of surgery that requires laterality so I always mark them myself in a place that will be visible when the drapes are on. Imaging is also always up on screen for everyone to verify we're doing the correct side. Along with several other safety checks before steel ever meets skin that are pretty standard.

Here's an interesting article about wrong site errors:

‘When Right could be so Wrong’. Laterality Errors in Healthcare

www.ncbi.nlm.nih.gov

 

[Volatile]

Anesthesiologist here, I remember reading a study about surgical site marking by patients the night before surgery, can’t remember the exact details but something like 70% got it correct, 20% forgot, and 10% marked the wrong side 😔. Gist is a decent percentage of patients have no idea what’s going on when they arrive for surgery….and these were patients having elective scheduled surgery :/

 

[Ligament]

This 20+ year SDN member (omg) appreciates the perspectives!

 

[Ligament]

Where you perform surgery, are you required to have both you (the surgeon) and the patient mark the surgical site?

 

[dpmd]

Where you perform surgery, are you required to have both you (the surgeon) and the patient mark the surgical site?

In the hospital I have to mark the site myself. At the surgery center they have the patient mark it so I can just check to make sure it is correct and not have to find a marker. I like that way better but I do always check to be sure it is the correct site. I haven't had someone mark it wrong yet.

 

[akwho]

I have never worked at a hospital where the patient marks the operative site. It's discouraged because it just confuses things.

Surgeon marks while verbally confirming site with patient. Mark should be visible when drapes are on. Images up showing correct laterality. That's my safety check as the surgeon.

Plus the preop and circulating nurses ask the patient about 10x in the morning as well.

 

[Ligament]

Seems like very few surgeons are required to have both themselves and also the patients mark the surgical site.

 

[Handinhand]

This is like when someone proposed also marking the "wrong" site for surgery. I don't think it caught on and there was a lot of backlash over creating unnecessary confusion.

I do a lot of surgery that requires laterality so I always mark them myself in a place that will be visible when the drapes are on. Imaging is also always up on screen for everyone to verify we're doing the correct side. Along with several other safety checks before steel ever meets skin that are pretty standard.

Here's an interesting article about wrong site errors:

‘When Right could be so Wrong’. Laterality Errors in Healthcare

www.ncbi.nlm.nih.gov

Especially if you are working in a field that operates on extremities, I find it very helpful to not only mark the correct limb that you are operating on, but to also mark the actual incision that you plan to make, at least roughly.

I work in hand surgery and doing things like trigger fingers can lead to side/site mistakes, as you've got two limbs and 5 fingers on each limb. However, if you mark your incision in pre-op, with the patient awake and having just gone over the consent, it's a lot hard to **** up when you're in the operating room and see you have a planned incision for a right index and ring finger trigger release.

 

[Lem0nz]

I always ask the patient. Say the same thing in pre-op every time: "This is gonna sound stupid but what side are we operating on today? I want to make sure we all agree. I have never operated on the wrong side and I never plan to so I want to hear it from you and me out loud." Then mark the patient myself.

 

[longhaul3]

We do a lot of surgeries that are difficult for patients to understand. Right-sided weakness or spasticity can be caused by a left-sided brain problem or a right-sided (or midline) spine problem. A single brain lesion can cause both left-sided weakness and right-sided visual/oculomotor deficits—which side are we operating on? Forget about the patients; many med students would struggle with that question.

Plus many of our patients can't even consent for themselves, let alone mark the correct side.

 

[ChiDO]

In residency and fellowship, both patient and surgeon marked site.

Currently in practice, only surgeons mark site where I work now.