Risk .. procedure or site must be within the parameters of the signed consent form and verified.
Using an Alternative Site. Marking Form to Comply With the Universal Protocol. ELIZABETH NORTON, BSN, RN, CNOR. The intent of the Joint Commission's
This guide to marking forms part of the interna onal High 5s project. surgery: the preopera ve verifica on check list; surgical site marking; and the final “ me-out"
noncompliance with surgical site mark- ing. The biggest 2. a process for surgical site marking. 3. a time-out in the OR . the count sheet. • When setting up for
Using an Alternative Site Marking Form to Comply With the Universal The intent of the Joint Commission's Universal Protocol™ is to prevent wrong site, wrong
Pre-operative marking has a significant role in promoting correct site surgery, . incident report form is completed in line with local governance procedures.
quality nurse developed a form for alternative site marking. This new form meets the Joint Commissions intent and was approved by the CHB OR governance
Where appropriate surgical site marking shall be undertaken preoperatively: consent form, patient, booking information, and imaging data when applicable.

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August 2017