Wrong COUNTS....

  1. I am new to the OR, and while I know that an incorrect count is not a good thing... but just how bad *is* it...? Are you subject to disciplinary action for it? Like, I dunno.... can someone explain??
    For instance, my facility has had I think 5 incorrect sponge counts in the last 2 months.... the missing sponges were never found, x rays taken in all cases.The educator is po'd. Where do these sponges GO???!!!! I dont understand.
    I found out the other day that a case I had started had an incorrect sponge count, when I *know* the initial count was correct. (I was relieved for the day, the nurse told me the next day). Am I going to be disciplined for this? I really dont know where this falls..... when the count is wrong, but not left in the patient.....
    Can anyone shed light on this for me? Now I am scared, wondering if I can handle this OR gig....
    (besides the basics, I know why we do counts, when, etc just want to make that clear)
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  2. 21 Comments

  3. by   ewattsjt
    this is my opinion for what it is worth.

    there are many factors involved in this scenario.

    first, was it always the same room staff, meaning the same scrub? remember that it takes two to count and if any disciplinary action is involved, it should involve both parties.

    the second part of your statement where you were relieved; you should always perform a shift change or relief count to clear you from the responsibility should someone else loose it. if you left with a good count, it is documented and can not come back to haunt you.

    third on what count was there a difference? 1st, 2nd, or 3rd. if it is the final count, i have seen them become lost in the back table stuff.

    fourth...."5 incorrect sponge counts in the last 2 months"... is just plain unacceptable. call me hard, callous or whatever but it is unacceptable. it can and will happen from time to time but this statement is too much!

    while i have not seen any disciplinary action for incorrect counts, i have never seen this type of consistent mis counts. i think that it should be something that can generate disciplinary action. it is not a matter to be taken lightly. the x-rays taken exposed the pt to unnecessary gamma rays because of the wrong count. there is the potential of having to re-open the patient before they leave or even have them to come back if the x-ray missed it too (unlikely but possible). the incorrect count is documented in incident a report which makes the surgery department and the hospital or surgery center look bad.

    i know my reply is not what you were looking for. i wish you well in your endeavors.
  4. by   RNOTODAY
    Quote from ewattsjt
    this is my opinion for what it is worth.

    there are many factors involved in this scenario.

    first, was it always the same room staff, meaning the same scrub? remember that it takes two to count and if any disciplinary action is involved, it should involve both parties.

    the second part of your statement where you were relieved; you should always perform a shift change or relief count to clear you from the responsibility should someone else loose it. if you left with a good count, it is documented and can not come back to haunt you.

    third on what count was there a difference? 1st, 2nd, or 3rd. if it is the final count, i have seen them become lost in the back table stuff.

    fourth...."5 incorrect sponge counts in the last 2 months"... is just plain unacceptable. call me hard, callous or whatever but it is unacceptable. it can and will happen from time to time but this statement is too much!

    while i have not seen any disciplinary action for incorrect counts, i have never seen this type of consistent mis counts. i think that it should be something that can generate disciplinary action. it is not a matter to be taken lightly. the x-rays taken exposed the pt to unnecessary gamma rays because of the wrong count. there is the potential of having to re-open the patient before they leave or even have them to come back if the x-ray missed it too (unlikely but possible). the incorrect count is documented in incident a report which makes the surgery department and the hospital or surgery center look bad.

    i know my reply is not what you were looking for. i wish you well in your endeavors.

    i wasnt "looking" for anything but the correct info, and thanks for your input.
    yes, the amount of wrong counts is unacceptable,and currently under review... but that wasnt my question, exactly... it was more like, where do the sponges go??? how can they be not accounted for, in the room, pt, anywhere?
  5. by   ewattsjt
    Sorry. I misunderstood.

    When I have had a wrong count, it has always been found in the room somewhere. If drapes are pulled before the final count is done, it has been there for me.

    I have also found two meshed together where it looks like one. We go through all the sponges we have and unroll, unfold them all the way open to see if there is only one.

    We have also found them mixed in with the back table trash on the larger procedures.
  6. by   RNOTODAY
    Quote from ewattsjt
    Sorry. I misunderstood.

    When I have had a wrong count, it has always been found in the room somewhere. If drapes are pulled before the final count is done, it has been there for me.

    I have also found two meshed together where it looks like one. We go through all the sponges we have and unroll, unfold them all the way open to see if there is only one.

    We have also found them mixed in with the back table trash on the larger procedures.
    Those are things I thought happened, but in all the cases, the sponges NEVER turned up.... and I am thinking, "well, they HAVE to be somewhere!!!
    I dunno...
    I am just concerned about the case I was involved in right now... I am still new, and this is obviously the first time for me... and I forgot to do a count at change of shift, so theres a lesson learned there....
    thanks ewattsjt....

    its also my first week off orientation, so I am not used to being the sole circulator yet....
  7. by   RNOTODAY
    Oh, and one more thing ewatts
    From what I can tell, where I work, before we declare a wrong count, they will tear the room APART, thus, if they find it, the count is not wrong... know what im saying? before we fill out an incident report, the garbage is spread, the field searched, under the table, everywhere
  8. by   ewattsjt
    We do the same. Like I said, we have always found the lost sponge when tearing the room apart. It is very interesting that the lost sponge could not be found even with tearing everything apart.

    I wish I had something I could tell you that could help. Something just doesn't sound right.

    Good luck with it!
  9. by   chartleypj
    Quote from RNOTODAY
    I am new to the OR, and while I know that an incorrect count is not a good thing... but just how bad *is* it...? Are you subject to disciplinary action for it? Like, I dunno.... can someone explain??
    For instance, my facility has had I think 5 incorrect sponge counts in the last 2 months.... the missing sponges were never found, x rays taken in all cases.The educator is po'd. Where do these sponges GO???!!!! I dont understand.
    )
    Incorrect counts on 5 different cases is real cause for concern. Placing blame, and then disciplining staff for mistakes will not fix the problem.
    Education, including rewiew and perhaps revision of the hospital count procedure might improve the situation.
    Do you adhere to any of the ARON recommended practices in your OR? I adhere to AORN RP's to the extent my facllity will allow.
    Are your sponges/ laps in packs of 5 or 10? It is so easy to double-count when handing countables during a hectic case.
    Also, saving all wrappers ( I know, a little cumbersome) might help in documenting the numbers of packages opened during a case.
    Good luck,
    Pj
  10. by   Jarnaes
    Like previous people have said- if the count is off, we tear the room apart, and go through the trash item by item. Missing sponges have been found inside a removed glove in the trash, in the drapes, stuck together with another sponge, under the back-table, step stool, or OR table. Have even found a needle stuck to the bottom of someone's shoe.
    In my time in the OR I may have had an incorrect initial count, but have always (knock on wood) found the missing item once we begin the big search. The usual culprit for lost items is inattention to detail by the staff.
    As an OR nurse you have to be hypervigilant, watch all and everything and trust no-one. As a new OR nurse it takes a little time to find your rhythm and your routine, just hang in there. After a while you will develop a functional form of OCD. And you too will become an evil OR nurse
  11. by   Marie_LPN, RN
    Where i work:

    If the couont is short, pt. stays on the table asleep, x-ray is taken, room is torn apart until missing item is found.

    If the count is "over" (more on the table than on the count sheet), x-ray is taken.
  12. by   TracyB,RN
    A raytec getting stuck & rolled in a lap bundle is a biggie. Have seen that happen a few times. Or, sometimes things fall on the floor & get stuck under the table.
  13. by   kleinbbc
    My biggest place to find lost laps is in the bottom of the trash. Having doc's look at me like I'm on drugs turning over trash cans to find them.
    1. seen docs wipe prep site then throw the lap across the room into the trash.
    2. doing two procedures when breaking down the draps things fall and people like to pitch things in the trash.
    3. Also I have heard tech's say if they don't like the nurse then things will come up missing.
  14. by   Marie_LPN, RN
    3. Also I have heard tech's say if they don't like the nurse then things will come up missing.
    Good grief.

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