Roles & Responsibilities
These OR team members must visualize the surgical items being counted.
Scrub and Circulator. The policy states that the role of the RN circulator is to "Visualize the surgical items being counted" and the role of the scrub person is to "Count surgical items in a manner that allows the RN circulator to visualize the surgical items being counted."
True or False. You can place 2 sponges in one pocket of a sponge counter bag in order to save space.
False. The policy states "Each sponge holder holds only one size and type of sponge."
When should you perform a closing instrument count?
The policy states "Before closure of a cavity within a cavity (e.g., the uterus).
What is the standard process for counting when a countable item is passed off or dropped from the sterile field?
The policy states "If an item is passed or dropped from the sterile field, the RN circulator should retrieve it using standard precautions, show it to the scrub person, safely isolate it from the field, and include it in the final count."
Should a count be denied if any OR team member asks for a count for any reason?
As long as the timing is appropriate, a count should be performed any time when an OR team member requests to do so.
This OR team member must record the counts of soft goods, sharps, miscellaneous items, and items placed in the wound.
RN Circulator
Is it necessary to use a sponge counter bag, or can you just keep sponges in the kick bucket?
The policy states "Any perioperative member can request that a sponge counter be used." In addition, "At the time of the final count, used sponges are in the sponge holders, with no sponges remaining in the kick bucket."
This is when the baseline count should be performed.
The policy states "Before the procedure to establish a baseline (i.e., initial count). This is to be done prior to incision."
When dressing sponges are on the field before the incision is closed, what is protocol for this?
The policy states "Dressing sponges included as part of custom packs should remain sealed and isolated until the wound is closed."
Are we required to do an instrument count for organ procurement cases?
The policy states "Instrument counts may be waived for surgical invasive procedures in which accurate instrument counts may not be achievable or practical, including organ procurements."
Where should counts be recorded during the case?
The policy states: "Record counts on a standardized template in a location that is visible to the surgical team (e.g., the count board/standardized count sheet); and that the scrub person agrees with. It also states that the RN circulator should "Add soft goods, sharps, and miscellaneous items to the whiteboard or standardized counting sheet after they are added to the sterile field."
What does the policy state to do when the sponge holder is full? Can we cross that amount off the whiteboard and throw them away?
The policy states " Upon verification by the scrub and RN circulator that the sponge holder is full, a slash may be drawn by the circulator RN through the corresponding count number on the dry erase board starting at the top. The full sponge holder should be removed from the IV pole and isolated in a clear plastic bag but not removed from the room.
Describe what counts should be done when there is relief of the RN circulator or scrub person for short durations (e.g.; a 15 minute break).
The policy states "Counted items in use should be accounted for when there is relief of the RN circulator or scrub person for short durations."
When packing is intentionally retained in the patient, what kind of sponges need to be used?
What is the policy on manufacturer packing errors, such as when a package of sponges does not contain the correct number?
The policy states "...the sponges are removed from the sterile field, isolated from countable items, labeled, and not included in the count."
During the surgical count, what should be minimized?
The policy states: "Minimize distractions, noise, and interruptions during the surgical count."
What needs to be visible on sponges when being counted?
The policy states that the radio opaque strip needs to be visible on each sponge.
Describe what counts should be performed when there will be permanent relief of the RN circulator or scrub (e.g. end of shift relief).
The policy states: "A complete count should be performed when there is a permanent relief of the RN circulator or scrub person. All items should be accounted for, although direct visualization of all items may not be possible."
What documentation is needed when intentionally retaining an item in a patient?
The policy states "The number and type of surgical sponges are documented in the EMR by the circulating nurse and the surgeon (ex. intra-op record and post-op note) and included in the hand off information shared with the health care provider at the transfer of patients care. The final sponge count is documented by the circulating RN as incorrect in the electronic medical record. An Unusual Occurrence report (UOR) is completed, and the OR manager and risk management are notified."
What steps should be taken if the scrubs hands are too busy to perform a closing count (e.g., they are holding retractors for the surgeon).
There are two options:
1. Wait until the scrubs hands are free to perform the closing count before skin closure.
2. Call the charge nurse to ask for another set of hands to scrub in and assist with the closing count.
These times are not appropriate times to perform the count.
The policy states: "Do not perform counts during critical phases of the procedure, including time-out periods, critical dissections, confirming and opening implants, care and handling of specimens."
When removing sponges from kick buckets, what needs to happen before counting them?
The policy states "Sponges should be removed from kick buckets, fully opened, and then placed into sponge counter bags with the radio opaque stripe showing."
Describe the order of locations that should be followed during counting (e.g., where do you start counting from, what is next, etc.)
The policy states "Counts of sponges, sharps, instruments and other miscellaneous items will be performed in order from large to small item size, proximal to distal from the wound (i.e., from sterile field to mayo stand to back table (s), and lastly to items passed off the sterile field).
When a patient who has retained surgical sponges comes back to surgery to have the packs removed, what should be done with the sponges?
The policy states "...the packing sponges are placed in a separate sponge holder."
When a patient with intentionally retained surgical packing comes back to the OR to have them removed, is it necessary to take an X-ray after they are removed?
The policy states "When no further packing is needed and wound closure is planned, intra-operative x-rays of the complete surgical wound should be performed at the closing count (before wound closure) to confirm that all surgical sponges, including packing sponges, have been removed."