Archive July 2017 XVIII, No. 7

You Can't Count on Counts Alone

Preventing retained objects not as easy as 1-2-3.

Dan O

Dan O'Connor, Editor-in-Chief


retained surgical items SAFETY IN CERTAINTY Retained surgical items occur regardless of whether the manual counts were correct, affirming the need for a verification process with adjunctive detection technology.

Like counting a deck of cards and getting 53 when there are really 52, most incidents of retained objects occur as a result of a miscount — a count documented as correct when, in fact, it was off. There's no shortage of explanations and excuses for miscounts: distraction, excess noise, time pressures, or trying to remember and count at the same time. Whatever the reason, so-called correct-count retention cases account for about 70% of the 4,500 to 6,000 cases of retained surgical items reported in the United States every year.

The most likely retained item? Seven of 10 times, it's a sponge. It's estimated that 11 patients every day are sutured up with a surgical sponge still inside them. As retained surgical-sponge incidents are often underreported, these statistics are likely low.

Then there are the near misses. A 2007 study from Brigham & Women's Hospital in Boston found that counts are off in 1 of every 8 surgeries. In none of the study cases was an item left in a patient's body, but the rate of faulty surgical counts is alarming.

What's clear from this muddled math is that the manual counting of surgical sponges, sharps and instruments is susceptible to human error and that manual counting alone is insufficient to prevent retained sponges. The Joint Commission, the Association of periOperative Registered Nurses (AORN) and the American College of Surgeons recommend the use of sponge counting and detection technologies to supplement and verify the manual count.

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