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

[Geani]

I saw a surgeon hiding a swab under his boot intentionally. I could not believe it, but I have been told that he's done it before.

[student987]

No clue why I read this post....having surgery on wednesday......

[goats'r'us, ASN, RN]

not really a countable item, but here's a scary one that's stuck with me..

before i started theatre nursing i was on a plastics ward, and i had this lovely woman who had had an abdominoplasty two years previously. unfortunately for her, her wound had not healed well, and she had suffered repeated dehiscences, had many returns to surgery, and now had extensive scarring across her lower abdomen.

on a previous admission, she had had the wound debrided and a VAC dressing placed, and glory be, it worked! her wound finally looked to be healing and she was so, so happy to finally have her life back.

sadly, though it almost healed, it was just never quite right.

two years and several admissions after her initial procedure, i had transferred to theatres, and saw her name on the theatre list for exploration and washout of her wound. i went out to see her pre-op, and she was understandably upset, praying that this would be the last time she'd be admitted, but no longer holding out much hope.

luckily, this WAS the last time, because this turned out to be the time that someone managed to locate the very well concealed and overgrown bit of VAC foam lurking deep in her wound.

terrifying how easy this mistake was to make. she'd had her initial VAC placed in theatre, and the surgeon had placed a few bits of foam, with bridges running between them, in order to fit the wound. he had not documented how many bits of foam had gone into the initial dressing, and when ward staff changed the dressing, one sneaky bit went unnoticed. the wound healed nicely over the foam, and it wasn't until months later when we went in for a relook that we found the little bugger!

now i'm the nurse who stands over doctors doing their op reports harassing them until they document how many bits of foam went into the dressing, and they all think i'm crazy. where is the justice in this world??