Journal of Patient Safety & Quality Improvement

Journal of Patient Safety & Quality Improvement

Evaluation of surgical site marking protocols in pelvic and knee procedures: a retrospective analysis in an orthopedic clinic

Document Type : Research Paper

Authors
Bircan Kara 1
Senem Güneş Kara 2
Rahşan Çam 3
1 Hatay Mustafa Kemal University Hospital, Hatay, Türkiye.
2 Hatay Traning and Resource Hospital, Hatay, Türkiye.
3 Aydın Adnan Menderes University, Faculty of Nursing, Department of Surgery Nursing, Aydın.
10.22038/psj.2025.88405.1472
Abstract
Introduction:
The fundamental principle of "first, do no harm" underscores the importance of safety in healthcare, particularly in surgical settings where preventable errors may occur. The World Health Organization's concept of safe surgery emphasizes accurate surgical site marking to reduce such risks. Healthcare workers’ awareness of this practice plays a vital role in ensuring patient safety. This study evaluates the prevalence and compliance of surgical site marking in an orthopedic clinic.
Materials and Methods:
This retrospective study reviewed patient records from the Hospital Information Management System of a university hospital's orthopedic clinic. It focused on pelvic and knee surgeries performed between January and March 2022. Out of 106 patients, 2 were excluded due to inaccessible surgical site marking forms, resulting in a final sample of 104 patients.
Results:
The mean age of patients was 54.4 years; 55.8% were female. Among the surgeries, 65.4% were elective, and 54.8% lacked surgical site marking. A significant association was found between the type of surgery (emergency vs. elective) and the presence of surgical site marking (p<0.05). Furthermore, surgical site marking status was significantly related to average hospital stay duration (p<0.05).
Conclusion:
Despite its critical role in patient safety, surgical site marking was often overlooked, especially in emergency surgeries. The findings highlight the need for improved compliance in orthopedic practices. Educational interventions, particularly those supported by artificial intelligence, are recommended to increase awareness and implementation of surgical site marking protocols.
Keywords
Safe surgery
site marking
patient safety
orthopedic clinic
Subjects

  1. References

    1. Borchard A, Schwappach DL, Barbir A, Bezzola PJAos. A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery. 2012;256(6):925-33.
    2. Albaadani MM, Bataweel AO, Ismail AM, Yaqoob JM, Asiri ES, Eid HA, et al. Ten Quality Improvement Initiatives to Standardize Healthcare Processes. 2024.
    3. Canbolat Ç. Ameliyathane hemşirelerinin ameliyathanede hasta ve çalışan güvenliğine ilişkin görüşleri: Sağlık Bilimleri Enstitüsü; 2011.
    4. Wong ZS, Waters N, Liu J, Ushiro SJSD. A large dataset of annotated incident reports on medication errors. 2024;11(1):260.
    5. AORN. 2024 Updates to AORN Guideline for Safe Patient Handling and Movement. 2025.
    6. Sewell M, Adebibe M, Jayakumar P, Jowett C, Kong K, Vemulapalli K, et al. Use of the WHO surgical safety checklist in trauma and orthopaedic patients. 2011;35:897-901.
    7. Weiser TG, Haynes AB, Dziekan G, Berry WR, Lipsitz SR, Gawande AAJAos. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. 2010;251(5):976-80.
    8. Külahlı HB, Pakyüz SÇJEÜHFD. Hemşirelerin Tıbbi Hata Yapma Eğilimlerinin ve Etkileyen Faktörlerin Belirlenmesi. 2023;40(1):91-101.
    9. Candaş B, Gürsoy A. Cerrahide hasta güvenliği: güvenli cerrahi kontrol listesi. ERU Sağlık Bilimleri Fakültesi Dergisi. 2015;3(1):40-50.
    10. Çiftçioğlu G, Kuzu HJSAK. Güvenli Cerrahi Kontrol ListesiTR: Klinikten Ayrılmadan Önceki Evrenin Uygulanma Durumu. 2022;7(1):36-46.
    11. Wang ManLi WM, Tao HongBing TH. How does patient safety culture in the surgical departments compare to the rest of the county hospitals in Xiaogan City of China? 2017.
    12. Toor AA, Nigh-e-Mumtaz S, Syed R, Yousuf M, Syeda AJB. Surgical safety practices in Pakistan. 2013;8(7.7):7.
    13. Gökay P, Taştan S, Ayhan H, İyigün E, Can MFJGlTD. Use of The World Health Organızatıon Surgical Safety Checklist: A Systematic Analysis. 2016;58(2):136.
Journal of Patient Safety & Quality Improvement
Volume 13, Issue 3
Summer 2025
Pages 179-184