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What Steps Do Hospitals Take to Avoid Retained Surgical Items?

There are certain things that should never happen when you go into surgery. These are aptly referred to as "never events" because of its seriousness and preventable nature. An example of this would be retained surgical items, such as sponges, needles, and components of a surgical device.

While it is true that surgery always comes with some risk (hence all the consent forms), there are ways to minimize, if not eradicate, some of those risks. The Association of periOperative Registered Nurses (AORN) Journal recently published updated guidelines for prevention of retained surgical items. In it, they emphasize the importance of establishing a conducive environment for preventing retention of surgical items, identify the best practices to account for such items, and how to effectively resolve any count discrepancies should they arise.

Creating a Safe Environment:

  • Perioperative team members should actively participate in formal team training programs that teach communication and teamwork
    • Implement standard language to communicate critical information
    • Provides ways to navigate potential hierarchical boundaries
    • Key is to clearly express any safety concerns and confirm that they have been heard
  • Count should be performed before patient is brought to the operating room
  • "No-interruption zone" to limit distraction
  • Standard reconciliation procedures
  • Methodical wound exploration
  • Radiological confirmation of a retained surgical instrument

Best Accounting Practices:

  • Perioperative teams should employ consistent, standardized counting methods
  • RN circulator and scrub nurse should conduct the counts
  • Both should view the items being counted while one separates and points out each item and count audibly
  • If possible, RN circulator and scrub nurse should do all subsequent counts
  • Subsequent counts should take place:
    • When new surgical items are added to the surgical field
    • Before closure of a cavity within a cavity
    • When wound closure begins
    • When the scrub nurse or RN circulator is relieved
    • Any time a count discrepancy is suspected
    • When the final count is performed
  • Each organization should implement a standardized count protocol for recording all counts during a surgery (i.e. count sheets/count boards)
  • Any surgical soft goods should be deposited into a "kick bucket" and subsequently organized into a pocketed sponge bag or similar system
  • Surgical devices and attachments should be inspected for damage and/or fragmentation immediately after removal from surgical wound

Resolving Count Discrepancies:

  • "Whoever notices the count discrepancy has to speak up"
  • Should get verbal acknowledgment from surgeon that count is incorrect
  • Thorough search of the operating room, tables/trays, and surgical site should immediately be performed
  • RN circulator and scrub nurse should perform a recount
  • If still missing, radiologist should be consulted to conduct imaging
  • If unable to be located through imaging, the RN circulator should document all measures taken to locate missing item and the surgeon should consult with patient to plan follow-up care

Hopefully these updated guidelines will help prevent these types of accidents from happening, but if you or someone you know have suffered harm as the result of a retained surgical item please contact our office today to see if we can be of assistance of you.

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