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Marking a patient for surgery

BMJ 2005; 331 doi: (Published 06 August 2005) Cite this as: BMJ 2005;331:s56
  1. Ravinder Singh, specialist registrar in trauma and orthopaedic surgery
  1. East Kent Hospitals

“Wrong site” surgery is an uncommon event, which can have catastrophic consequences for both patient and surgeon. The most common surgical procedures started or performed on the wrong side are knee arthroscopy, surgery on a fractured neck of femur, and nephrectomy. Marking a patient for surgery is an essential risk management activity, and if done correctly can reduce wrong site surgery and ensure the correct procedure is performed.

  • The operating surgeon or a nominated deputy from the surgical team should mark all patients before they are sent to theatre

  • The patients' identity, intended procedure, and medical notes should be reviewed and correlated

  • Indelible marker should be used. Water based marker pens can wash off or transfer to the contralateral limb

  • The arrow should not cross the area of the surgical incision

  • The procedure should be written on the limb to minimise “wrong procedure.” Abbreviations should be avoided

  • Digits should be labelled—as thumb, index, middle, ring, little, in the hand, and as great toe, second, third, fourth, fifth in the foot

  • The member of the surgical team doing the marking should initial the arrow on the patient and document the fact in the medical notes

  • In theatre the operating surgeon should recheck the patient's mark with the consent form and medical documentation before commencing surgery.

By following these simple guidelines consistently, wrong site surgery can be reduced to a minimum. For more information see the National Patient Safety Agency's website ( ■


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