Roles of Nurses in Surgical Site Markings

In December 2004, in response to an inquiry, the Board reviewed information published by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) entitled, “Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery” (July 1, 2004); and “Frequently Asked Questions about the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery.”  The JCAHO has published the following information:

Who should mark the site?:  The protocol states, "The person performing the procedure should do the site marking."  The word "should" is in contrast to the more definitive term "must," which is used elsewhere in the protocol. It recognizes the need for flexibility to accommodate the logistical and procedural realities of the full range of surgical facilities.  When it is not feasible for the person performing the procedure to mark the site, another member of the surgical team who is fully informed about the patient and the intended procedure must do the marking.  In this context, the preoperative registered nurse is considered a member of the surgical team.  Any delegation of responsibility for marking the surgical site must be consistent with applicable law and regulation (we are advised that some states may prohibit nurses from marking the surgical site).  The organization must 
ensure that whenever the responsibility for site marking is delegated to someone other than the person who will be doing the procedure, the safety of the patient will not be compromised.  Note that while the Protocol requires that the patient be involved in the process, it is not expected, or even recommended, that the patient mark his/her own surgical site.

The Board advised that surgical marking should be performed as indicated by JCAHO, and that it is within the scope of nursing practice for a nurse to accept the delegation of responsibility to mark a surgical site as indicated in the JCAHO response entitled  “Who should mark the site?”