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The Association of periOperative Registered Nurses and The Joint Commission issue joint statement on National Time Out Day

Wednesday, June 7, 2023

Despite decades focused on preventing wrong site surgery, it continues to occur at a predictable rate. National Time Out Day, on June 14, brings renewed attention for everyone on the surgical team to pause before a surgical procedure begins to ensure it is the right site, right procedure and right person. 

The Joint Commission addresses the Time Out in its Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery™. For this year’s National Time Out Day, the Association of periOperative Registered Nurses (AORN) and The Joint Commission are focusing on the full attention of all team members during the Time Out, as well as the importance of visible site markings. 

For busy operating rooms (ORs) that perform hundreds of surgeries a year, it can be easy to treat the Time Out as mundane. However, it provides the very last safety check before incision for the team to communicate and address any concerns. Just one error at any time in the preoperative process can lead to cascading errors and patient harm. 

Extreme care must occur when marking the procedure site. Root cause analysis (RCA) often suggests site-marking errors contributed or resulted in wrong site surgery. To help ensure accurate, meaningful and visible site markings, Haytham Kaafarani, MD, MPH, FACS, chief patient safety officer and medical director, The Joint Commission, suggests:

  1. Marking the site as close and clear to the actual site of surgery as possible. For example, a site marking for surgery on the fourth finger placed at the wrist to protect the surgical site opens the door for a wrong finger to be operated on. Instead, mark the actual surgical site at the finger — or, if not possible, mark the wrist but add an arrow to the fourth finger.
  2. Utilizing radiographic imaging when site marking is not possible for non-visible organs. For example, surgery to the L4 of the spine cannot be marked. Good practice is to have the imaging in the OR and review it as a team to double and triple check surgical site accuracy prior to incision and during the procedure.
  3. Keeping the site marking visible especially at key steps of the procedure, including the Time Out and at the time of incision. The site marking should not be intentionally or accidentally placed under the drape. Every member of the team should confirm the site marking is done, visible and appropriate – the Time Out provides an opportunity to recheck correct surgical site marking as a team.

“While wrong site surgery is rare, one occurrence is one too many,” adds Dr. Kaafarani. “Together, surgeons, anesthesiologists, nurses, surgical technologists and other members of the surgical team must work together to prevent this type of adverse event. We need to approach every surgical case as if it could be the wrong site surgery one and make every effort from preop to postop to prevent such an adverse event from occurring.” 

AORN CEO/Executive Director Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, adds, “As the patient advocate in the OR, perioperative nurses must be passionate champions for an effective Time Out and assure that each member of the team understands the protocol and takes this critical safety check seriously – for every patient before every surgical procedure.” 

Additional key actions to reinvigorate preoperative safety practices are available in Periop Today and on

AORN and The Joint Commission encourage healthcare organizations and surgical team members across the country to join us in stressing the importance of the Time Out during National Time Out Day and year-round.