Archive March 2017 XVIII, No. 3

Make Sure Nothing's Left Behind in a Patient

Define the roles and responsibilities each team member has in the counting process.

Mary Fearon

Mary Fearon, MSN, RN, CNOR


nothing left behind LOST AND FOUND X-ray detectable sponges are sometimes easier to spot in the surgical wound.

A cannula fragment was discovered in a patient's knee 6 years after his arthroscopy. A surgical sponge was found lodged in a patient's abdomen 4 years after her hysterectomy. A gastric band was detected during a sleeve gastrectomy conversion. Every year, an estimated 4,500 to 6,000 cases of retained surgical items are reported in the United States: soft goods, sharps, instruments and small miscellaneous items.

The manual counting of surgical sponges, sharps and instruments is susceptible to human error; that's why we haven't been able to eliminate retained objects. Items are left behind most frequently in the abdomen and pelvic areas, from where they can migrate to the intestine, bladder, thorax and stomach. The consequences can be devastating. Retained surgical items can result in reoperation to remove the missing object, post-op infection and, in rare cases, even death.

Retained items generally involve a deviation from routine counting practice caused by distractions, excess noise, time pressures, multi-tasking, fear of speaking up or poor teamwork. Your surgical team members must work together to develop a standardized, transparent, verifiable and reliable counting protocol — and then hold each other accountable to following it. Active participation in the process improves communication and teamwork. You must first define the roles and responsibilities each team member has in the counting process.

Circulating nurses. They must ensure there are no counted items remaining in the OR from the previous case as they set up the room. They then perform the initial count, with help from a scrub tech, by noting the number of soft goods, sharps and miscellaneous items on a whiteboard in the OR for everyone on the team to reference. They can never assume that counts indicated on packaged supplies are correct and must count out individual items before documenting the initial tally. If extra supplies are opened during the procedure, circulating nurses should update the count noted on the whiteboard.

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