Where have you found missing countable items?

[IdahoGrad]

Hi, I am an experienced med/surg RN who is new to the OR and am in a training program where we are to present a topic to the group. My topic is Counts/Preventing the Retention of Foreign Bodies. I'm trying to come up with something interesting besides a power point on the policy! (a lot of our training so far has been power points of safety topics.... important but kind of dry...)

I would love to give other new OR nurses tips on where to look for items missing during closing counts. Any good stories of how an item was found or where it was found would be helpful. I have also heard that a few surgeons like to hide things as a joke for new staff, just to watch them sweat during a count. Has this ever happened to you? Where did the surgeon hide things and how did you handle it?

Any other suggestions on how to prevent the retention of foreign bodies or how to present this topic in an interesting manner would be so helpful. If anyone has any little tips or tricks on how to make sure the first count is correct, goes smoothly, and how to have good communication and timing with scrubs about the count, that would be great!

Thanks,

Julie, RN

[fracturenurse]

Let's see...

Raytec will cause a problem if they get real bloody, they get tucked in the folds of our kickbucket which is lined with a red bag. You really have to look for them.

Laps thrown away accidentally and yes, the shoe thing. Needles getting stuck in a shoe, twice we have found them in the bottom of a surgeon's shoe.

Came close to losing those rumi rings, surgeon forgot to remove them after a laparoscopic hysterectomy. Scrub nurse mentioned it, and the assistant went in the lady parts and pulled it out. Ugh.

Scary.

[OldORgirl]

Shoes, med student & x-ray tech pockets and (my personal favorite) in the pathology department- delivered with the specimen by the attending surgeon!

We are using an RF system now and it's GREAT for finding sponges in trash, linen etc!

FYI: If you are using a Stryker Rover suction and you are missing a small item (peanut, vascular needle, vessel loop, etc) you can use a mini C-arm to check the manifold! (This trick has saved me several times!)

[kat von b]

Found a lap under the OR bed, must have fallen and then gotten kicked under it so all that was peaking out was the very edge. Missing raytec in the red kick bucket...after multiple people searching through everything another tech comes in, looks down and goes "is this it", the other nurse and I wanted to die LOL

[Robbone]

Ahhh the joys of searching for missing countables. The cuff of the mayo stand drape is notorious for harboring all sorts of items. Best practice is to unfold that cuff........

[Owensaunt]

I worked at a level 1 trauma in ohio. We had a trauma pt come in and they were doing a bowel resection. The count was over by 1 lap which was found in the bowel. The patient had pica and had eaten a lap that they bought on the internet prior to their accident. Talk about an investigation.

[Robbone]

No way!! Why a lap I wonder? Hoping to sue????? You win for the most bizzare story!

[canesdukegirl, BSN, RN]

Found a thin malleable in the trash that was wrapped in a blood soaked towel. A hand drying towel that should have never gotten to the field!

[msn2010]

I know!!! why doesn't surgeons/resident do not listen when we say we are counting!?!?!

A lot of times when we are missing rayt/lap, I ask MDs (at appropriate time) if they have any before counting from the field. I had number of cases where they were holding it with their hands or tucked away.

Also, some of the staff will hide instruments on the may under the towels and will not tell you about it.

Couple of months ago, I was told by one of the staff that 4 hospitals that are in same service area as my organization had huge fine due to retaining foreign objects inside the patient. These were what they found: Fred liquid bottle, scratch pads, raytec, q-tip, pathology specimen.

[maryorrn]

A scrub nurse used a sponge before the case started to wipe the patient's hand and left it on the armboard. We searched trash, drapes, inside gloves, floor, and every nook and cranny. The scrub insisted I somehow must have let it leave the room, or that we were somehow shorted by the manufacture and didn't catch it on our first count. When we were ready to order an X-ray, the anesthesiologist found it when adjusting the patient's arm.

[ChristineAdrianaRN, BSN, RN]

I flipping hate counting needles. A travel nurse I work with told me a place she used to work would employ the practice of filling up a needlebox, counting it once, and then snapping it shut, so you can just count by 50 or whatever number it holds instead of counting each one individually each time. Does any of your workplaces do this? Sure would be nice to not have to individually count 97 needles four times in a case...

I know this is an old thread and the question about ideas on how to present this topic is old news, but I was going to suggest spreading some needles out on the floor, getting a couple of those magnetic roller things, and letting audience members loose to try to find them...:)

[Rose_Queen, BSN, MSN, RN]

We do the needle counter thing, just slightly differently: ours hold 40, and once filled, they are counted and handed off the field. Then when we do the closing count, the circulator will say "I have 40/80/120 needles, and the scrub starts counting on the field with 41/81/121.

[ChristineAdrianaRN, BSN, RN]

Yeah, I think that's what she meant. Man, that would be nice. I'm still orienting and that high of a needle count has only happened to me once, but if I end up in the plastics room or the heart room, I may ask my manager about it...