Marking the Surgical Site

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Surgery is increasingly becoming a trend the world over as cosmetic surgery, and other types of physique-enhancing procedures gain popularity. Research indicates that more than 50% million operations, minor or otherwise are carried out In the United States. This number does not put into account the number of plastic and other cosmetic surgeries ("FastStats", 2016). Despite technological advancements and specialized research that give patients a higher chance of survival, there are other variables during surgery that compromise safety and the patient's survival chances. Proper identification and marking of the surgical site are one of the most crucial variables in ensuring the success of operations. According to research, between 1,000 and 2000 wrong site surgeries are carried out in the United States alone (Stahel, Mahler, Clarke, & Varnell, 2009). More than half this number of operations result in near misses whereby the patient's life is almost lost or develops additional complications that require further treatment. The Universal Process of surgery site marking introduced in 2004 dictates that marking be done in three phases (Stahel, Mahler, Clarke, & Varnell, 2009). However, most hospitals rarely have time to adhere to the protocol owing to heavy workload and constrained resources. Patients, therefore, resort to marking their sites, and in cases where surgeons do so, they mark them in a hurry on the operating table.

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Target population

The formulation of a Policy on marking surgical sites is aimed at giving a clear protocol to the parties involved in surgeries and dispelling patient and staff ignorance or indifference. The most affected by the policy on marking surgical stuff are the pre-operative staff that analyzes the patients condition, give specialized advice in different areas such as neurology, podiatry, anesthetics, and so on depending on the patients condition. Although not all surgeries require such specialized consultants, they are responsible for advising the nursing staff on proper site markings before surgery (Nemeth, 2008). The nursing staffs that monitor the patients condition and manage their hygiene are also targeted by the policy. Excluding emergency operations, most surgeries are pre-planned for hours or days depending on the severity of the condition. The fact that a patient can go through all the preparatory stages for days and finally get to the operating table without proper site marks affirms the importance of this policy. Additionally, other external entities such as patients scheduled for surgeries will be sensitized on the necessity of good site marking before surgery and will hence be able to demand as much from the hospital staff.

Population needs

In marking surgical sites, some factors arise. Most methods of site marking employ the use of nontoxic markers registered with the FDA and recommended by The Association for periOperative Nurses (AORN). However, patients needs differ owing to the skin color which results in varied visibility especially when chlorhexidine-based skin preparation solutions are used (Mears, Davani, & Belkoff, 2009). Consequently, hospitals might lead in the use of other methods such as permanent markers depending on the needs of the patient. Additionally, the location of the marking brings into question the need for temporary markings that will withstand skin preparation but fade away very quickly after surgery. However, patients might not have any objection to the use of standard markings on openly visible areas that might last longer ("Surgical Site Markers: Putting Your Mark on Patient Safety", 2016).

Identifying these needs is square to the doctors and nursing staff that conduct preliminary investigations, and monitor patients vitals before surgery. Failure to which, surgeons making site markings on the operation table might make marks, which become indiscernible on the skin color after site sterilization or last for a longer period than the patient would wish.


The primary purpose of the policy on surgical site markings is to establish a protocol that will ensure patients are marked for surgery, the markings are verified, and patients needs are met. The policy will lay out a procedure and allocate responsibility to the various parties involved in surgery. Moreover, having a structured protocol will help assign blame or identify future faults for further revision of the procedures. The policy will ensure that at least one external party is sensitized on the importance of correct site markings, which will subsequently enable them to demand as much from the medical staff before surgery. That is, in cases where the patient is in an unresponsive state, the closest next of kin will be sensitized on the matter so that they can demand proper care on behalf of the patient.

Process and procedures

The adoption of a list that includes all parameters that a patient must fulfill before entering the operating room will be imperative to the success of the policy. The list can be posted in patient rooms and issued to patients kin in case the patient is unconscious. In so doing, all parties, internal and external will be aware of all the preparations needed and will be able to note in case a step such as surgical site marking is skipped. Open discussions with the patients and their kin, which will include discussing surgery details and the checklist, will help in efforts to curb disregard for site markings. Moreover, patients will also be in a better position t disclose their preferences as far as the location markings are concerned without compromising surgical standards. After discussions, pre-surgery verification process should be implemented to ensure that all the correct details of the patient are captured. They will help inform on the correct surgical markings, which will be drawn on the patient before entering the operating room and after the doctors and nursing staff have taken final observations and hygiene measures respectively. Upon entering the operating room, all tasks in the first checklist should have been cleared including marking surgery site. The patient should then be prepared on the operating table, where the surgeon and other consulting specialist verify the markings before the commencement of the surgery.


Implementing the policy lies squarely with the hospital management who will vet, approve, or recommend amendments based on the hospitals policies and financial resources. Upon approval, the hospital management should ensure that all staff is educated on the new policy and proper measures such as documenting the new protocols and pinning the new checklist on appropriate places is done. Theater nurses should confirm that the checklist is fulfilled at the operating room door. Feedback from both external and internal parties should be collected after a few months to help monitor the progress of the new system


Proper marking of surgery sites is one among the many issues facing the various practice stings. Hospitals need to formulate policies and implement structures that will ensure wrong-side surgeries do not happen. The policy should focus on assigning tasks and responsibility to all staff involved before surgery. Additionally, patients should be aware of the necessity for proper surgery markings before going into the operating rooms. When both parties, internal and external, are aware of the procedure, it is less likely that double mistakes will occur.


FastStats. (2016). Retrieved 15 July 2016, from

Mears, S. C., Davani, A. B., & Belkoff, S. M. (2009). Does the Type of Skin Marker Prevent Marking Erasure of Surgical-Site Markings? Eplasty, 9, e36.

Nemeth, C. (2008). Improving healthcare team communication. Aldershot, England: Ashgate.

Stahel, P., Mehler, P., Clarke, T., & Varnell, J. (2009). The 5th anniversary of the "Universal Protocol": pitfalls and pearls revisited. Patient Saf Surg, 3(1), 14.

Surgical Site Markers: Putting Your Mark on Patient Safety. (2016). Retrieved 15 July 2016, from (4)/Pages/130.aspx

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