Where have you found missing countable items?

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    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
  2. 26 Comments so far...

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    1. Sponges wrapped up together in the sponge counter bag
    2. Sponges mixed in with the trash
    3. Needles under the OR bed
    4. Needles on the shoe covers of the person who just left the room
    5. Hemostat still in the abdomen (surgeons refused to believe it was there and continued closing- they had to completely reopen and then reclose after the xray proved them wrong)
    6. Sponge tucked up behind the liver (found on first count, surgeon still had enough of the incision open that he didn't have to cut any sutures)
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    I haven't got into the OR yet, but in LTC, we had a very very ill lady who was passing nasty foul BM's...she'd had ABD/intestinal surgery...she later passed a gauze at our facility.
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    I never had an MD intentionally hide anything, but I have had med students and residents who threw away the prep sponges because they didn't realize they were to be counted. Easy enough to find in the trash or laundry hamper (that's why trash & laundry should never leave the OR room until after the case) but it was time consuming to have to stop and look.
    I have also had a sales rep who thought he could help himself to the "clean" prep sponges left over on the prep stand. (NO, take those out of your pocket - I have to keep counting them until the end of the case and the case isn't over just because YOU walk out of the room).
    My favorite though was the 7-0 needle (about the size of an eyelash) that we looked everywhere for (try finding an eyelash in a bloody sponge bucket) just to discover it was stuck to the back of the surgeon's glove
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    cottonoid stuck to shoe
    raytech inside a glove finger (how/why I don't know)
    cottonoid got sucked up inside suction canister

    My least favorite though is when I had 1 too many raytecs. We finally came to conclusion that it was left in kickbucket from previous case.
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    The most horrid thing that I have heard regarding a retained item was a cervical ring retractor that was left in after the leaving/relief shift did not give appropriate report. This is one of the last things to come out of the pt during hysterectomies. The pt had multiple complications as a result. Truly sad, and totally preventable.

    Yep, the lap pad behind the liver.

    I have seen really nasty scrub nurses intentionally hide needles in the drapes to sabatoge the count (this was a mystery to me...she should have known that she would also get in trouble for this, but she was so full of nastiness that she couldn't see that her logic was seriously flawed.)

    Most of the time, laps and raytechs are in the trash.

    I found a 6-0 Prolene in the tread of the surgeon's Dansko.

    I found a 3-0 Vicryl pop on the other side of the room after the surgeon slammed it on the mayo and it disengaged from the needle holder.
    msn2010 likes this.
  8. 0
    Quote from canesdukegirl
    The most horrid thing that I have heard regarding a retained item was a cervical ring retractor that was left in after the leaving/relief shift did not give appropriate report. This is one of the last things to come out of the pt during hysterectomies. The pt had multiple complications as a result. Truly sad, and totally preventable.

    Yep, the lap pad behind the liver.

    I have seen really nasty scrub nurses intentionally hide needles in the drapes to sabatoge the count (this was a mystery to me...she should have known that she would also get in trouble for this, but she was so full of nastiness that she couldn't see that her logic was seriously flawed.)

    Most of the time, laps and raytechs are in the trash.

    I found a 6-0 Prolene in the tread of the surgeon's Dansko.

    I found a 3-0 Vicryl pop on the other side of the room after the surgeon slammed it on the mayo and it disengaged from the needle holder.
    Wow, that's just mind boggling. I work with some nasty scrub nurses but that one takes the cake!

    I've found suture needles in all kinds of interesting places. Dangling from gowns, at the bottom of quivers, underneath trays, even found one in a surgeons boot!

    Lap sponges are more difficult to hide, usually behind the liver or spleen.

    I was circulating for a minor procedure and the consultant managed to lose a raytec gauze in such a small incision that we had to get an x-ray. It was hard for any of us to believe it was even in there but it was...

    Last year we had to reopen a patient who had a lap sponge left in for about a 7-8 years. I couldn't believe just how intact it still was
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    Thanks, everyone, for all your great replies! This makes me look forward to our presentations tomorrow, now that I have something more fun to put up on the projector screen than a power point
  10. 0
    here is one I have experienced-
    one of the docs scrubbed out, rolled gown and gloves off, with a sponge in his hand, and threw in trash. you would think that they would realize he had a sponge in his hand, but sometimes you just do things like that.
    also, we have found a raytec stuck to someones shoe--- in the lounge!!!!
  11. 0
    I wasn't personally involved in this case but a dacron tape was found in the suction canister after 45 minutes of frantically searching. That's about the oddest thing that I've heard of.

    A needle was once found behind the drapes with anesthesia after the surgeon slammed the NH on the mayo and lost it.


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