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- by carcha Sep 24, '03do 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 this in so wrong as instruments have been known to be left in patients and surely as an accountable practitioner you owe the patient a duty of care to ensure the count is done. Am i wrong .
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- Sep 24, '03 by chartleypjcarcha
AORN's recommended practice says "Instruments should be counted on all procedures in which the liklihood exists that an instrument could be retained" (2003 Standards, Recommended Practices & Guideleines, p.223) # 4 under this recommended practice states how, that is audibly and with 2 individuals. Our hospital policy is written to include that instrument counts be done in cases where body cavities are opened, i.e., brain, peritoneal, bladder, uterus, chest, for example.
How in earth can anyone in this day and age NOT make an effort to follow a recommended practice prescribed by their national specialty organization?
- Sep 24, '03 by shodobecarcha, 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
- Sep 25, '03 by acuteobrnWow, not counting??? Now that is just crazy. I work OB and we count a total of 4 times for a c/s (two instrument, two item counts) Just unthinkable, because it is very easy to leave something behind. I would follow AORN standards like chartleypj recommends. We had a hospital sued in my area for leaving a 1 1/2 inch wide maluable in a pt...how they missed that one I just cant figure out. Found it when the pt. tried to fly to visit some relatives and couldn't get past airport security.
- Sep 26, '03 by carchayeah I knew I was right. I've spoken to my friend to let her know how vunerable she is leaving herself by being bullied into not doing a count, shes young and dosent want to upset her head nurses . believe it or not, she's under the impression that if a case went to court, her defence for not counting instruments, ie the head nurse told me so would hold up. the thing is that, where the girl works, the head nurses dont scrub. SO , another question, what if the particular facility u work in dosent have a policy on counts. is she covered?
- Sep 26, '03 by IowaKarenHi, I'm a nursing student and just the other day I was in surgery watching a lumbar spinal fusion during my neuro/ortho rotation. When the primary surgeon was finished with the fusion, the secondary Dr. was closing up the incision. The circulating nurse discovered a sponge missing (the COUNT was short), told the scrub nurse and then the Dr. stopped what he was doing (getting ready to pull the deepest set of sutures closed) and hunted for almost 1/2 a minute before discovering the sponge. Wow, wouldn't that have been a disaster if not caught. All in all, it didn't seem THAT time consuming to make the initial count and the last count when the surgery was finished so why would anyone want to take the chance! :stone
- Sep 26, '03 by chartleypjcarcha,
Is that to say the hospital your friend works in hasn't any policy on counts? Somehow that just doesn't seem possible in this day and age where patient safety first is critical.
- Sep 26, '03 by acuteobrnDon't they have to answer to AORN standards??? I thought that these associations were in place to help give some sort of national standard for accredidation by JCAHO???
- Sep 28, '03 by carchamy friend works in a hospital in europe, not the usa or uk. however I know shes not happy not doing an instrument count, and I can only imagine the pressure she and others feel when they finish a case worried the they may have left an instrument inside and praying to god they havent. How in this day and age can a head nurse be allowed to get away with it. What is her rationale?. I'm so puzzled by this one
- Oct 1, '03 by Chrislynn2003I;m a new grad, but we are required to do a baseline count, a count when we are being relieved by someone, count new instruments/sharps when they are added to the field, count prior to wound closure and a final count