Correct Site Surgery

Pre-operative marking recommendations

The role of marking to promote correct site surgery
Pre-operative marking has a significant role in promoting correct site surgery, including operating on the correct side of the patient and/or the correct anatomical location or level (such as the correct finger on the correct hand).

Using the NPSA’s pre-operative marking recommendations and verification checklist
NHS organisations without a robust alternative will need to use the NPSA’s pre-operative marking recommendations and verification checklist.

A new checklist will need to be fixed to patient notes and completed for each new surgical procedure. Therefore, NHS organisations will need to ensure that copies of the checklist are reproduced and made available at a local level. The standard layout of the verification checklist may be adapted to meet local needs, for example to make additional room for addressograph labels or handwritten details.

Pre-operative marking recommendations
The National Patient Safety Agency (NPSA) and the Royal College of Surgeons of England (RCS) strongly recommend pre-operative marking to indicate clearly the intended site for elective surgical procedures.

1. How to mark
A surgical skin marker pen should be used. The mark should be an arrow that extends to, or near to, the incision site and remain visible after the application of skin preparation. It is desirable that the mark should also remain visible after the application of theatre drapes.

2. Where to mark
Surgical operations involving side (laterality) should be marked at, or near, the intended incision. For digits on the hand and foot the mark should extend to the correct specific digit. Ascertain intended surgical site from reliable documentation and images.

3. Who marks
Marking should be undertaken by the operating surgeon, or nominated deputy, who will be present
in the operating theatre at the time of the patient’s procedure.

4. With whom
The process of pre-operative marking of the intended site should involve the patient and/or family members/significant others wherever possible.

5. Time and place
The surgical site should, ideally, be marked on the ward or day care area prior to patient transfer to the operating theatre. Marking should take place before pre-medication.

6. Verify
The surgical site mark should subsequently be checked against reliable documentation to confirm it is (a) correctly located, and (b) still legible. This checking should occur at each transfer of the patient’s care and end with a final verification prior to commencement of surgery. All team members should be involved in checking the mark.

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