Say WHAT to Count
The circulator opens a new 4-O Vicryl suture to the scrub tech during the surgical procedure, this occurs immediately
What is verify/count the new suture with the scrub tech and write the update on the white board/instrument count sheet
Rationale: (policy page 3 section B #1, section C #5 a,b and page 5 section F)
A baseline count is established at this point
What is at the beginning of procedure, prior to the patient arriving to the OR.
Rationale: (policy page 4, section D#1)
These counting aspects are listed on the White Board
What are soft goods, needles, miscellaneous items
Rationale: (policy page 4, section C #4)
The count is not correct, these are the following steps (not documentation) that occur next
What is:
* notify the surgeon
* complete a recount
* if still incorrect after the recount, the surgeon should complete a wound search and the scrub team should search the drapes, field, Mayo and back table. The circulator should search the count bags, trash, linen, floor and all items that have been counted off the field.
*if still incorrect above the above steps: notify the charge nurse, call for an X-Ray.
Rationale: (policy, page 6 section L #1)
This is documented in the operative report when intention was utilized
What is the name and quantity of the instrumentation and/or type of sponge/item left in the wound is documented in the operative report
Rationale: (policy, page 7 section N #1)
This count method is included for all open surgical procedures
What are complete count including soft goods, needles, instrumentation, and miscellaneous items
Rationale (policy page 3 section B)
This occurs at the start of closing the first layer (peritoneum, fascia and muscle, skin)
What is a complete count including instrumentation
Rationale: (policy page 4, Section D #3)
These are tallied and compared to the number listed on the package
What are needles
Rationale: (policy, page 4, section C #5a)
The count is not correct, this is the documentation and action that occurs (multiple answers)
What is:
*submit an event report
*notify charge nurse / leadership
*document in the OR nursing report and in the event report the following:
*the incorrect count,
*all steps taken to resolve the count including the name of the Radiologist who read the X-Ray, the name of the surgeon who was notified about the incorrect count,
*patient will be informed through communication and Optimal Resolution (CANDOR) of unanticipated outcomes.
Rationale: (policy page 6, section e)
This must be included in the hand off report and subsequent visits for the patient when intention was utilized
What is the number and type/s of sponges used for packing and all other items intentionally left in the wound.
Rationale: (policy page 7 section N)
*When the previous packing is removed the sponges used will be reconciled with the type of and number previously documented in the medical record. If the wound is repacked the process repeats with the documentation process in the medical record. If the previous packing does not reconcile with the medical record, an event report is completed.
This is completed for all minimally invasive procedures prior to the patient entering the OR
What is a baseline count will be completed.
Rationale: (Policy page 3 section E #5) A final instrument count does NOT occur if the case did NOT convert to open. In the event the procedure CONVERTS TO OPEN, a final instrument count WILL occur.
Instruments must be counted when this occurs
What is closing a cavity within a cavity
Rationale: (Policy, page 4 Section D #2)
Method for the Circulating RN and scrub to follow when counting
What is direct visualization of each counted items as it is being counted out loud together
Rationale: (policy, page 4 section C #1)
Reading of the X-Ray by a Radiologist for inaccurate count occurs when the patient is located here
What is the patient remains in the OR
Rationale: (policy page 6, section L#1e)
This must occur when the wound is finally closed after intentional items are removed
What is complete an X-ray of all quadrants of the cavity.
Rationale: (policy, page 7 section N #7)
This count is included when closing an organ procurement procedure
A complete count will be completed. Including soft goods, sharps, instruments and miscellaneous items.
Rationale: Final counts must be done on patients who are organ donors and/or patients who expire in the OR (policy page 5, Section IV H #5)
This occurs during the count whenever a patient is in lithotomy position
What is a cavity exam
Rationale: All cases in which the patient is in lithotomy position a cavity exam must be completed along with the final count and documented in the surgical debriefing (policy page 4 section D #5)
Balfour wingnut, Bookwalter retractor, Uterine manipulator all have this in common in regard to how to count
What are instruments with removable parts that will be counted as individual pieces.
Rationale: (policy page 4, section C #6)
These two factors are considered with waiving the need for an X-Ray
What is
* item/s has the potential of not being X-Ray detectable: needles smaller than 10mm
* patient's condition is determined to be unstable by the surgeon
Rationale: (policy page 6, section L #1 EII)
Negative Pressure Wound Therapy (NPWT) requires this when dressing the wound
What is writing on the provided label or in indelible ink on the external dressing to include the number and type of dressing items.
Rationale: (policy, page 7 section O #1)
This is included in the count any time an anatomical plane is crossed into an open space.
What is instrument count
Rationale: Any body space including, but not limited to: abdomen, thorax, pelvis, stomach, bladder, heart, lungs, uterus, vaginal cavity, colon, or any area that has a potential space for the retention of items. (policy page 2, section II definitions)
Separate counts must be conducted and documented when (at least three responses required):
What is:
* relief of any permanent surgical staff in the procedure
* multiple procedures involving multiple sites are performed
* whenever a surgical team member has a concern regarding the accuracy of the count
Rationale: (policy page 4, section D #6)
This occurs when the package contains an incorrect number of items
What is isolate the entire package and contents from the field and remove from the OR
Rationale: (policy, page 4 section C #3)
This occurs when a final count is missing a lap sponge during an organ procurement procedure
What is notify the surgeon, complete a recount, complete a room and field search, and perform an X-Ray.
Rationale: (policy, page 6, section L#1)
This is done for clear visibility that must occur when dressing items are applied to a tunneling wound
What is maintaining a visible tail for ease of access and/or removal
Rationale: (policy, page 7 section O#3)