The COUNT of Montecristo
Keeping track of the location of items used in and around the sterile field to protect patients from retained objects.
What is the surgical count?
Sponges, needles, knife blades, cautery tips and cleaners.
What is a soft count?
Thoroughly explores the surgical site and removes any counted items before beginning closure.
Who is the surgeon?
To count audibly and view concurrently
to see and speak simultaneously during a count, establishing that both individuals are engaged and viewing the same item at the same time.
This device MUST be used to 'house' all used sponges
Sponge counter bag.
Name at least 3 types of sponges that are required to be counted.
What are raytec, laps, peanuts, tonsil sponges, neuro patties?
Only these types of sponges can be used during surgery.
What is x-ray detectable or radiopaque?
Records the results of all counts on the EMR and count sheet.
Who is the circulator?
When a pt. must be packed with countable sponges, the circulating nurse must document this during the first surgery
What is the number and type of sponges packed, and note the count as incorrect for procedure 1, and report this information to the receiving RN.
According to SBMC policy, 'a scrub person must'
1. do THIS on all procedures not requiring the opening of peritoneal, retroperitoneal and or thoracic cavities, and
2. will utilize this to do so.
1. Confirm integrity of all items prior to the surgical team use and prior to closure of the cavity/end of procedure. inventory count
2. Utilize the instrument set inventory sheets
This must be completed for every surgical case except for Cystoscopy, burns and Intraocular procedures,
What is an appropriate surgical count/count sheet
The scrub must do this to every sponge packet in front of the OR nurse just prior to counting them.
What is break the paper band?
Record pertinent information related to the pt. and planned surgical procedure,and document any extraneous or instrument pieces that will be viewable to the entire surgical team.
This must be documented for a pt. who has been packed with counted sponges for procedure 2
What is verify number of sponges removed with previous nurses notes in OR documentation, document case 1 final sponge count as correct, and arrange for an X-ray post op, prior to leaving the OR to verify there are no additional retained items.
May not be used by anesthesia or in a dressing.
What are counted sponges?
List at least three times a count is needed.
What are initial, closure of any cavity, skin closure or final layer, and permanent relief of scrub or circulator?
This is the ONLY acceptable method of counting sponges.
Drop count method
If a count remains incorrect or if it is resolved after an X-ray is taken this must be done.
What is complete a Verge report and notify your manager or charge nurse immediately?
This is the method for adding sponges to the count tally.
5+5+5, 10+10+10, etc.
Surgical Counts at the sterile field must be conducted in this order
Field, Mayo, back table, off the sterile field
All pieces must be accounted for, bagged and taken to the specialty manager
What is a broken instrument or disposable instrument.
In the event of an incorrect count who can review the x-ray prior to leaving the OR.
Attending surgeon or staff radiologist?
These must be counted on all surgical cases regardless of size
Suture needles.
This is the FIRST thing that must be done when a count has been deemed incorrect by the RN circulator
What is notify the operating surgeon and team of what is missing and how many are missing, to halt the closure process unless doing so is deemed unsafe by the surgeon, as such surgeon is required to notate in pt. record.