Responsibility
Who is responsible for performing surgical counts in the OR or other invasive procedure setting?
Who is the RN circulator and scrub person.
Preventable "never events" that can be reduced by implementing multidisciplinary system and team interventions.
What is retained surgical items.
Where does the final surgical count start, progress, and then end?
What is at the operative site, progressing to the mayo, back table, and finally the sponge receptacle.
What does the AORN recommendation for performing counts audibly, visually and concurrently mean?
What is the method of visualizing items during the count, counting out loud and counting together.
When should dressings that contain nonradiopaque sponges be placed on the sterile field?
What is when the final count is completed and the incision is closed. All nonradiopaque dressing sponges contained in a "custom pack" will be removed from the sterile field prior to incision.
Who can initiate a surgical count?
Who is anyone who has a concern about the validity of the count.
What is the best way to prevent surgical items left in the patient upon discharge from the operating room?
What is the surgical count process.
When is it permissable to NOT perform a final count?
What is when the surgeon determines that the patient medical condition warrants.
The final count may be resolved by x-ray, which may occur at the next level of care if the surgeon determines that delay in transfer to the next level of care could potentially compromise the patient status.
What is the preferred method to reconcile counts for sponges and sharps that aid in transparency to the entire surgical team to visualize the count?
What is the white dry erase count board?
When is the practice of reconciling the number of needles against the number of packages valid?
What is never. The practice of reconciling the number of needles against the number of packages is not valid reconciliation to determine a correct or incorrect count. Using empty suture packages to rectify a discrepancy in a closing needle count is not recommended.
In the event of an incorrect count, who needs to be notified?
Who is the surgeon and other operative team members, the charge nurse, and radiology, if an x-ray is needed.
What is the radiopaque strip on sponges used for?
What is to detect location of the sponge in the body during x-ray to prevent a retained surgical item in the patient.
When are surgical instruments counted?
What is:
- before the procedure to establish a baseline
- before closure of a cavity within a cavity
- before wound closure begins
- at skin closure and end of procedure
- at the time of permanent relief (scrub/RN)
In the event of a count discrepancy, the Radiology Imaging Protocol is initiated, which requires what radiographic view(s) to be obtained by radiology?
What is a single view AP radiograph, or PA if the patient is prone, of the entire operative field.
What is required documentation for counted sponges used as postoperative packing?
What is the number and types of sponges retained, the reason for the variation and confirmed as correct by the surgeon in the "Packing" query under "Assessment" tab in Meditech.
An armband must be secured to the patient's wrist prior to leaving the OR suite with the following documented on it: patient's full name and date of birth, # and type of sponge retained, date and time packing occurred, circulating RN's name and surgeon's name.
In the event of an incorrect count and x-ray, who reads the film before the patient can leave the OR?
Who is the radiologist. The intraoperative radiograph(s) will be immediately interpreted, and report called to the surgical suite.
What is the meaning of a "never" event per TJC standards?
What is a preventable occurrence that results from a patient safety event resulting in death, permanent harm, or severe temporary harm.
When are surgical instrument counts performed?
What is on any procedure in which a body cavity or hollow organ is entered, or when the operative site is such that an object could be retained.
Instrument counts are required to be performed for laparoscopic procedures.
What is the appropriate method of filling the count bags?
What is sponge counter bags should be filled from the bottom up and have a solid-colored backing so that each sponge can be visualized by the entire surgical team.
At the end of the procedure, all sponges should be accounted for by placing each sponge in a pocket of the counter bags to verify that all sponges are accounted for.
What identified situations can potentially contribute to the risk of retained surgical items?
What is:
-emergent nature of the procedure
-unexpected change during the procedure
-patient obesity
-high blood loss
-long procedure
-competing demands on personnel
-lack of standardization in the count process
-communication breakdown
-multiple surgical teams
-shift changes
-pressure to increase throughput (reduce OR time)
-staff member inexperience
Who is responsible for prevention of retained foreign bodies?
Who is ALL team members.
What is meant by the term miscellaneous countable item?
What is an item small enough to be retained in the patient during surgery, radiopaque or non-radiopaque, and must be identified per P&P so that all surgical team members are counting the same item.
What are the critical portions of a procedure in which counts nor events that would require a count should be performed?
What is time out periods, critical dissections, confirming and opening of implants, induction of anesthesia/patient anesthetic emergency, and care and handling of specimens.
What is documented regarding the surgical count in the patient's intraoperative record?
What are all personnel involved in performing the count, what items are counted, when the count occurred, the count results, and any actions taken, if needed.
When are additional counts needed?
What is:
- opening of a hollow organ or retroperitoneum.
- bilateral procedure
- multiple stage operation
- scrub tech/RN relief
- request for an iterim count
- intraoperative death
- organ retrieval procedures