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Patient safety

How to mark a surgical site

Other platforms explain it with text and video. In Making Synapses you practice it on the patient.

MD / DOPA
Practice it in VR with Blocky

Marking the site is part of the Joint Commission Universal Protocol. It prevents surgery on the wrong side or wrong level.

Step by step

  1. Know when to mark

    Mark when there is more than one possible side, structure or level, such as limbs, eyes or digits. [1]

  2. Who marks

    The person doing the procedure, or a qualified delegate per policy, marks the site. That person will be present during the procedure. [1]

  3. Involve the patient

    Confirm the patient's identity and ask them to state the procedure and site. Mark while they are awake if possible. [1]

  4. Use a clear mark

    Use a skin marker that stays on after prep and an unambiguous mark, such as initials. Do not use an X, which can be confusing. [1]

  5. Mark at or near the site

    Place the mark so it is visible after draping. [1]

  6. Use another method if needed

    If the skin cannot be marked, such as mucosa or teeth, use a written alternative per policy. [1]

  7. Recheck at time-out

    Confirm the mark is visible and matches the consent before starting. [1]

Common errors

Practice it in Making Synapses

In Making Synapses you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.

Making Synapses cases that train this skill

36 Making Synapses cases train this skill: open the case library

Sources

  1. The Joint Commission, National Patient Safety Goals

Facts and steps follow The Joint Commission, National Patient Safety Goals. Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.