Audit of Operative Site Marking Practice in a Tertiary Hospital in Nigeria: A Key Step in Patient Safety.

Background: Wrong-site surgery (WSS) is the most frequent sentinel event, accounting for 13.4 % of all sentinel events, with an incidence of 0.09 - 4.5 per 10,000 surgeries. Adherence to recommendations for surgical site marking to prevent WSS remains poor, with paucity of data on WSS due to underreporting.

Methods: The first institutional audit of preoperative site marking in Nigeria was prospectively conducted in the 11 surgical and obstetrics and gynecology units of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, between March-April 2024. Data obtained was analysed using the Statistical Product and Service Solutions (SPSS) version 25. Associations between surgical characteristics and operative site marking were ascertained using chi square, with the level of significance set at a P value of <0.05.

Results: Surgical site marking was done for only 36.4 % of surgeries involving laterality. Surgical site was marked in 90.2 % of cases by junior resident doctors (RDs) and nurses, and paper tape was used for marking in 92.2 % of cases. There were significant associations between surgical site marking and surgical specialty (P<0.001) and urgency of surgery (P=0.001), with ophthalmology (94.0 %) and general (17.6 %) surgeries, elective surgeries (41.8 %), consultant/attending-led surgeries (41.1 %), and major surgeries (43.8 %) involving laterality being significantly more likely to be marked compared to emergency (0.0 %), RD-led (29.3 %) and minor (30.3 %) surgeries.

Conclusion: The practice of surgical site marking in OAUTHC is low. There is need for institutional and national protocols on surgical site marking and the education of surgical and theatre staff on its benefits, to engender a change of practice for patient safety.