Archive July 2018 XIX, No. 7

The Count Is Off - Now What?

We created a step-by-step poster to resolve incorrect counts and hung it on every OR wall.

Emily McKisson

Emily McKisson, MS, BSN, RN, CNOR


HUNG WITH PRIDE Emily McKisson, MS, BSN, RN, CNOR, and Chris Marchese, RN, stand before the poster-size algorithm that outlines everyone's tasks in the event of an incorrect count. The poster hangs in all 80 ORs at the Ohio State University Wexner Medical Center in Columbus, Ohio. Download a free PDF at In Ms. McKisson's right hand is a cottonoid similar to the one left in a patient during a 2016 neurosurgery.

How do you resolve an incorrect count at your facility? Whether it's as simple as a dropped hemostat that you didn't hear hit the floor or as serious as a missing sponge that didn't show up on a foreign body X-ray, you would hope that your surgeons and staff would follow your incorrect count policy to the letter, taking exactly the right steps in exactly the right order whenever the count is incorrect, unresolved or unreconciled.

Of course, we know that's not always the case. Not all of the staff scrubbed in for a case are familiar with your policy, and some surgeons rarely encounter incorrect counts. In the heat of the moment, there can be a lot more questions than answers.

  • When does the surgical team continue or pause closure? When do they search for the missing item or order a foreign body X-ray?
  • When does the scrub tech conduct a first closure count or repeat count? When does she continue to search for the item?
  • When does the circulator conduct a first closure count or repeat count? When does she inform the attending surgeon or call the OR desk/charge nurse? Does she place a foreign body X-ray order?

That's a lot to remember and a lot to do. What every OR team could use is a step-by-step, role-defined guide to help resolve incorrect counts. We think we've come up with a pretty good solution — and it hangs prominently on the wall in all 80 of the ORs here at the Ohio State University Wexner Medical Center in Columbus, Ohio.

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