At the moment we're having a huge issue at my work with scrubbing in for a case, when the instrument nurse needs to scrub out due to fatigue, hunger, been there too long etc.
Our current practice is that a count is done between the existing scrub and the scrub taking over, and this must be done in the presence of the charge nurse.
The issues we're having is that some bright spark in management has decided we shouldn't be scrubbing in because ACORN policy doesn't recommend this and that having a changeover in the middle of the case can increase the chance of retained items.
When we questioned this theory on retained items, we asked if there was any evidence that this has occurred. We received a vague answer of 'historically it has'.
We were also told that it may annoy the surgeons because doing the count in the middle of the case can cause a delay. :icon_roll
Personally i think that the chances of errors occuring during a case would be increased by an overly fatigued scrub nurse who has stood there for ten hours without relief.
What are you thoughts, HCF policies on this?
Jan 30, '08
You are correct that the scrub person should be allowed a break. For any change in personnel at the table a count should be done with the oncoming person and the circulator- Our policy. Then if the count is incorrect we can determine when it became so. If the oncoming and circulator is counting this should not disturb the surgeon.:spin:
Jan 30, '08
Worked at (2) hospital OR's and the policy was the same at both. If you are giving just a lunch or coffee break, you don't need to count. If the crew is changing for permanent relief, a full count of instruments and sponges needs to be done. Could care less if the surgeon is annoyed when I count. To tell your employees that once you are scrubbed in to the case you can't leave sounds ill conceived. If you have a grievance committee at your hospital, I'd take it up with them and file on this.
Jan 30, '08
Our policy is when someone gets relieved permanently, a count needs to be done. I've never heard of scrubs
not getting relieved-it sounds like this management pinhead you're talking about has never scrubbed. Heck, it sounds as though he/she has little idea of how the OR works. I agree with the above post..you guys need to band together and fight this.
If counts are done correctly, they're effective. I also agree that the crankiness of surgeons should not be a determining factor in OR policy. I learned to tune out a surgeon's whining because I don't have the time for such childishness. The patient is the most important person in that room -not the surgeon(despite what some of them would have you believe).
Jan 31, '08
I'm not sure of AORN's chapter and verse covering this, but I think there's something in there somewhere.
We pretty much do the same, full, official counts are not done unless the scrub is leaving for the day.
That said, we don't break out a scrub tech for a coffee break, they take theirs in between cases. Lunch breaks we do.
During the hand off, the two techs will talk, the outgoing tech orients the incoming to the "lay of the land". This includes what we're doing, where we are in the procedure, suture being used, meds/fluids on the field. We'll do a sponge/needle count and if anything unusual with the instruments, we'll cover that.
About the only cases we don't relieve on is totals.
We don't do neuro/open heart, etc, and most of our cases are 3 hours or less.
I don't think that's right for anyone to be expected to be at their peak performance for that long a period of time!
Feb 3, '08
For my facility, it depends on the doc, what type of break, etc... Some of our docs do not allow for relief. If scrubbed in, you don't get a potty/coffee break unless you can fit one in between the cases. If we are relieved for lunch, we do a full count because it is possible to finish the case etc..while the initial scrub is on break. Our charge does not have to witness the count; it is confirmed by the circulator, the initial scrub and the relief.
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