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Archive March 2020 XXI, No. 3

Counts Aren't Always Correct

Barcode scanning and RFID detection help to make sure no sponge is left behind.

Daniel Cook

Daniel Cook, Editor-in-Chief


Pamela Bevelhymer, RN, BSN, CNOR
HIGH-TECH HELP Platforms designed to prevent retained objects should augment manual counts, not replace them.

Crack open a pack of sponges and count them before and after the procedure to make sure the same number that go into the patient also come out before the surgeon sews up the incision. Seems like a simple enough process. So why do sponges account for upwards of 70% of all retained surgical items? Perhaps because most retained sponges occur after incorrect manual counts staff assumed were accurate.

"There's always the possibility of the Swiss cheese effect — errors can occur even when several layers of preventative measures are in place," says Deb Hedrick, BSN, MA, RN, CSSM, NEA-BC, director of perioperative services at Lutheran Medical Center in Wheat Ridge, Colo. Human error is inevitable, she points out, even during the seemingly basic task of counting sponges.

That's why her eight-hospital health system invested in radio-frequency identification (RFID) sponge detection systems. Proprietary sponges are embedded with RFID tags, which are detected by the system's underbody mat and a wand that staff pass over patients. At the conclusion of a case, the circulator activates the detection mat, which scans the patient for tagged sponges left behind. According to the health system's policy, circulating nurses must also use the wand to check for sponges in patients with a BMI of 51 or greater. Ms. Hedrick points out the wand can also be used to scan the outside of trash cans in the OR in search of missing sponges if the manual count is off.

The technology works, but we didn't feel comfortable relying on it alone.
Valerie Marsh, DNP, RN, CNOR

Technology should augment, not replace, the manual count, says Valerie Marsh, DNP, RN, CNOR, perioperative education specialist supervisor at the University of Michigan Health System in Ann Arbor.

Nurses and surgical techs at her hospital use a barcode ID system to help confirm the accuracy of manual counts. They open a package of five sponges and use the system's touchscreen tablet to scan barcodes on each sponge to digitally document the "count in." The system captures which staff member did the scanning, the patient who is undergoing surgery and the number of sponges placed inside the patient.

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