counting instruments - page 2

by carcha

3,261 Visits | 13 Comments

do u all count your instruments where u work. we do a count before the case and again after pre closure. my friend works in a room where the instruments are never counted by 2 people because the head nurse says not to. I feel... Read More


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    Originally posted by shodobe
    carcha, your asking for trouble if you don't go by what chartleypj says. I remember an item in the news not to long ago about a patient that had a ribbon left in them. I swear it was from England. Mike
    Mike, the same exact thing happened a bit closer to home--Washington state. Had a malleable (ribbon) left in during a laparotomy. So weird to imagine that happening, since a ribbon is most commonly used like a visceral fish--while CLOSING. Can't see how it could have been left in, unless the patient was REALLY obese. Plaintiff (patient) got a huge settlement.
  2. 0
    Originally posted by shodobe
    carcha, your asking for trouble if you don't go by what chartleypj says. I remember an item in the news not to long ago about a patient that had a ribbon left in them. I swear it was from England. Mike
    Mike, the same exact thing happened a bit closer to home--Washington state. Had a malleable (ribbon) left in during a laparotomy. So weird to imagine that happening, since a ribbon is most commonly used like a visceral fish--while CLOSING. Can't see how it could have been left in, unless the patient was REALLY obese. Plaintiff (patient) got a huge settlement.

    I hate doing freakin' instrument counts, and I ALWAYS know what is on my mayo at any given time, because I keep the very minimum up there, and I only put instruments up in pairs--not odd numbers--and I placece whatever is no longer being used into a soak pan of water--so it is clearly visible, and also accessible, in the rare event it is needed again.

    However, now that newer scrubs tend to put ALL their instruments needed for the entire case on their Mayo stands at the beginning, and keep adding more instruments TO, not taking away, from the field, I think that instrument counts have become a necessity. Too bad, because in the '70s and '80s no one ever did instrument counts, and I never heard of any retained instruments, EVER.

    You know what you DO have to be careful about? Surgeons that put a blue towel in the pelvis. This is often during done during radical prostatectomies, and is a practice that I am highly uncomfortable with--you have to write it on the count board and make SURE it is out before closing. Usually only urologists do it, and it seems to be done about everywhere I have ever worked. No big deal, I guess, as long as you are careful to CYA by making sure that towel really DOES get removed.
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    It is really strange to hear from people how they just implemented a count in their OR in just the past few years. I have been doing this since 1977 and the hospital where I have worked has always had a count policy. I always assumed this was the standard only to find out it really wasn't. Each hospital had it's own policy to this affect. I think the majority of hospitals go by AORN standards now and we have to remember carcha is from the UK and I was wondering if they use these standards like we do. I also hate to count but it is second nature and it can go very quick especially if you lay everyhing out for the circ to see. You know the surgeon is going to want your complete attention when they close so the the circ will have to count pretty much for you. I prefer to count myself needles and sponges and will live instruments for the circ to count. I know this isn't the right way, you should devote your intire attention to the count but in reality the surgeon isn't going to go sit down while you count! Also you do have to watch these guys, they can be very sneaky when it comes to putting things in the abdomen without telling you. I make it a habit to announce loudly enough for the circ to hear so they can write it on the count board. We also have a poilcy that we do not have to get an order from the surgeon for an x-ray if something is missing. Small vascular needles are usually the only thing we do not waste time looking for because you can't see them on film anyway. Got to go now I have a Gamma Nailing to do in a little while. Mike
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    The thing is guys, that even in the u.k., even with a policy, not all work places practice counting instruments with 2 people. While its expected that u count sponges ect, in several places I have worked in there is no check between 2 people on instruments, pre op or post op. Now I can hear u all ready to jump on your keyboards to tell me how stringent u are in your counting, however let me repeat, not ALL places, I dident say every place, secondly, I have also worked in North America and the same thing applied in one hospital I worked in. I almost had to beg to do a first count in that one. Finally to protect my licence I gave up the O.R.. Again perhaps I was just unlucky in my choice of hospital, or time in that hospital. My point is unless the team in the OR enforce the policy or good sense, if there is no policy, what can an individual do but fight and fight, and let me tell u that wears u down after a while.


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