![]() ![]() It is also not reliable and responsible that the patient participates in the surgical site marking. Hence, it is often not possible that the attending surgeon or a resident marks the surgical site of the patient. The time available between patient’s entry at the surgical ward, pre-medication and transfer to the operating room is often kept very short to avoid waiting time, especially in efficiently organized outpatient or same day surgery. In everyday practice with same day surgery this is often impossible due to a crowded schedule in the operating room. Generally, it is recommended that the attending surgeon himself marks the surgical site on the patient before surgery. There is a large variance in the adherence to the principals of safe surgery and the use of checklists. The introduction of surgical safety checklists improved markedly the surgical outcome. One important cornerstone for eradicating WSS is the surgical site marking before the intervention. Many hospitals worldwide accepted the principles of safe surgery and introduced, inter alia, a team time-out before and after surgery. In 2008 the WHO introduced the safe surgery checklist with the aim to reduce mistakes in patient care and adverse events by improving teamwork and communication. But the true incidence might be higher due to a reporting bias. The incidence is estimated at 1 in 30.000 to less than 1 in 100.000 surgeries. Wrong-site surgery (WSS) is a complication with potentially devastating effects. However, the attending surgeon remains fully responsible of the correct operation on the correct patient. Surgical site marking can be performed by trained nurses. During the whole study time of almost 3 years, no wrong-site surgery occurred. For the remaining 10% either a surgical site marking was not necessary or the nursing staff asked a surgeon to mark the correct surgical site. 90% ( n = 115/128) of the surgical site markings were correctly performed. 22 data sheets were excluded from the analysis. 150 patient-accompanying checklists were analyzed. The stepwise implementation of the new concept of surgical site marking was well accepted by the entire staff. Data were collected by a patient-accompanying checklist that was completed by the nursing staff, the staff in the operating room and the responsible surgeons. 22 months after the introduction a prospective data collection monitored for one month whether the nursing staff carried out surgical site marking independently and correctly. 12 months after the introduction of the new concept an interim evaluation was performed asking whether the new process facilitates daily routine and surgical site marking was performed correctly. After this initial phase the new concept was introduced in the entire surgical department. During a pilot phase of 3 months (starting October 2012) the nursing staff of a single ward was trained and applied the surgical site marking on behalf of the responsible surgeon. The prospective non-controlled interventional study took place in a single primary care hospital of Uster in Switzerland. The aim of the study was to find out whether surgical site marking can be carried out reliably and correctly by nurses. Therefore we systematically monitored, whether surgical site marking can be performed by trained nursing staff. ![]() Particularly in the case of same day surgery, this recommendation is almost not feasible. Generally it is recommended that the attending surgeon performs the surgical site marking. Surgical site marking is one important cornerstone for the principles of safe surgery suggested by the WHO. ![]()
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