"Count Me In"
Name one orthopedic specific item counted during a total joint case.
Steinman pins
What color towels are used for packing the abdomen, and why?
Green towels, because they are radiopaque.
**REMEMBER TO ADD THEM TO THE COUNT**
If there is still a uterine manipulator in the patient you cannot verbalize a correct count - TRUE or FALSE?
TRUE
Who must be informed if the initial surgical count was not completed in an emergent situation?
The attending surgeon
What is the correct order to perform a surgical count?
A. red box, back table, field, off field
B. field, back table, red box, off field
C. field, off field, red box, back table
D. off field, field, back table, red box
B. field, back table, red box, off field
What is the correct number of counts performed on an open hernia repair with mesh placement?
4 - initial, mesh, closing, and final
An 8-0 suture is missing, do you need to do a x-ray?
No, a suture 8-0 or smaller is not detectable on x-ray
During a GYN laparoscopic case or DaVinci case, if all of your counts are correct and the surgeon inserts a sponge on a stick to check for bleeding, you do not need to count sponges again - TRUE or FALSE?
FALSE, all sponges must be counted again, visualized and bagged at the end of the procedure before the patient leaves the room. This applies to ANY procedure.
Your patient expires in the OR do you complete your closing counts?
Yes, but if they are incorrect you search for the item, an x-ray is not taken
What items are counted at temporary relief of any team member?
Sharps
How many counts are to be performed for a laparoscopic hernia repair with mesh?
3 - initial, closing, final
FALSE - Reference Policy: Counts: Retained Surgical Item Prevention, 23-04, item 13.
Sponges and sharps need to be counted for angiogram procedures - TRUE or FALSE?
TRUE - in case we have to open
What item is normally counted in every service but is excluded from the count in ophthalmology cases?
Weck spears
What items are counted at permanent relief of any team member?
Sponges and soft goods, sharps, and instruments if applicable
If a countable sharp (suture, bovie tip, etc) is dropped, it is ok to add a replacement, discard the original and have your count be "even" with no documentation needed - TRUE or FALSE?
FALSE. All counted items must be visible to both team members for the final closure counts.
Referencing policy# 23.04 - page 5, "Sharps", 4-5.
Where is an x-ray taken on an unstable patient when counts are omitted?
On the Post-Op Unit
At what 2 times do we count instruments during a robotic or laparoscopic TLH?
Initial and vaginal cuff closure
What items are counted for ALIF procedures?
Sponges and sharps - instruments counts are omitted and a flat plate x-ray is taken
Who is allowed to open countable items onto the surgical field during the case?
the Circulator only- the circulator is responsible for tracking countable items, and it is policy
How many counts are to be performed if there are 3 incision sites being closed at different times (no mesh)?
7 - initial, and 2 for each incision site (2x3=6)
When a patient leaves the room packed with counted items, when is an x-ray taken?
An x-ray is taken when the patient returns to the OR. The counted items are reconciled with the previous operative record and isolated from the current case surgical count.
***Remember to document the counted items that were used for packing***
During a hand-assisted laparoscopic procedure, should a final instrument count be performed?
A hypo is passed off the sterile field for local injection prior to being counted. Is this hypo retained for visualization or disposed of in a sharps container?
You are removing a blade (with an instrument) from a knife handle. The blade breaks and flies off your table. What do you do?
Alert your team and search the room, check your table, instrument, and handle for pieces. Be sure all pieces are accounted for.