bar coded sponge counting

MissJoRN, RN · Mar 14, 2006

I did see his documentary and the idea is nice... in theory... like so many others. Sponges aren't the only thing though, anything used in surgery has a potential of being retained. I think this is how he's trying to cope with what may have been poor technique in the first place. Sponges, instruments, supplies, and sharps should be counted, carefully, pre and post op. Any discrepency and the pt gets an XR. All sponges used... right down to the teeny neurosugical ones are already XR opaque. Is he really planning on barcoding neuro sponges?? Some hospitals have gotten away from nit-picky counting technique and are just getting back into the routine. I think we'll see a big decrease in retention, but yes, it will still happen. I noticed how slow the count went in his trial... yes it was a trial but no suurgeon is going to delay closing that long! I also noticed how they were trying to distract the circulator with real-life scenarios... That's a huge part of the probelm there: phones, pagers, etc. I've had the same desk secretary call my OR three time in a row during counts and get annoyed because I refused to answer. Oh well, when I'm counting, I'm counting. The only thing that will distract me would be an even more immediate patient safety issue. One hasn't happened yet! So I'm not really sure, we'll see and if it becomes widespread we just have to learn to adapt!

shodobe · Mar 16, 2006

This is a joke, right? I thought I have had heard it all but this one makes the top of the list. I think technology sometimes is going in the wrong direction. Another medical innovation that will make a lot of money for the inventor but hospitals will just throw it to the side because of cost and lack of interest. I still see where mistakes could still be made with this system. Let's just stay with the counting of sponges the "old" way because even with it's drawbacks it is still the best. Bar code sponges, what next!

MissJoRN, RN · Mar 16, 2006

This is a joke, right? I thought I have had heard it all but this one makes the top of the list. I think technology sometimes is going in the wrong direction. Another medical innovation that will make a lot of money for the inventor but hospitals will just throw it to the side because of cost and lack of interest. I still see where mistakes could still be made with this system. Let's just stay with the counting of sponges the "old" way because even with it's drawbacks it is still the best. Bar code sponges, what next!

No, sir, No joke. I happened to catch a program on Dicsovery or TLC about this. (I think hubby brought it to my attention. I avoid the OR shows because I get too distracted by all their big, shiny, fully stocked, well organized supply cabinets. Then I'm annoyed next time I go to work and run up and down the hall all day for stuff that should be available "but on TV, the big hospitals..." But that's a whole 'nother thread!)

They highlighted a case of a man who suffered sequelae of a retained sponge- real icky worst case scenario type stuff- then on to the surgeon (or, LOL!, he may have been a fellow) who came up with this ivory tower bar coding idea. Now don't think all the laps have a different scan than all the packs... each one is unique. His angle was that if a sponge is missing the computer knows exactly which one is missing (So? It can name it Pierre for all I care... just find it and get it out!!) Also, a little more useful IMHO, it prevents an interrupted circulator from counting the same sponge twice and thinking we have 50 if one is sill in the belly. BUT! That brings me back to... the nursing team should not be interrupted at this time. Ever. No matter the technology. And if they are, the count needs to start over at the beginning.

To refer to another current thread. We use the hanging divided bags for bigger cases, drape sheets or count from the bucket for smaller and smallest cases. Out post op count visualizes each seperate sponge. At no time to we bundle and bag them. When a sponge is left in, Dr. Couldntbeme insists we go through the sorting bags to ensure there aren't two in one pocket. PITA since I already did that, maybe twice, but whatever you say, Dr, I know I'll only look better after I prove it! I'd hate having to rip open 6 bundles to prove each only has 10. (What's that Dr. Couldntbeme? You found it? No! Not under the liver, I never imagined!) The program compared bar coding (in a lab setting of very controlled chaos) to a kick bucket method. Well of course, it looks to the average Joe "I'm so smart, I'm watching edjy-kational TV" Public like this is the first time anyone has tried an organized approach to counting!

Another question for Dr. Inventor... It doesn't happen often but... How do you want us to handle adding sponges to the field in case of an unexpected bleeding emergency? Right now our circ tosses a few bundles on the table, scrub grabs the first one, rips the paper band open, counts each of the five with circ at a rate of 1 per second and takes another 5 seconds to count them as she throws them on the mayo. Total- 10 sec. Subsequent bundles can be counted more slowly (they might take 20 or 30 seconds each) Right now Dr., your colleques often don't seem to think that is fast enough, and you feel your scrub is at the back table too long. There is a bleeding emergency and they want the scrub next to them, after all. How long will it take for the scrub to hold each sponge up the red beam from the gun the circ is holding?? C'mon, we all know how long a box of cereal can take to scan right! Surgeons will start to panic and yell, I'll start to panic and shake and that beam will never make contact with that barcode!

Sorry, I'm not sleeping well lately and seem hyper this AM! I should have just posted "no joke, has many kinks in the system" and gone back to bed!

shodobe · Mar 17, 2006

I still think it is a ridiculous idea! Sorry, old fashioned and still think using fingers and toes are just fine. Any system will have it's quirks and drawbacks and will be wrought with errors. One of these days there will be a error-free way of counting but until then I will stick with 1,2,3,5 laps, oops 4!

carcha · Mar 17, 2006

Yeah I saw this one too. My feelings are mixed as I believe if your going to bar code sponges why not other items?. I know a sponge is more likely to be lost then an instrument say, however, I feel in my heart its kind of a concept that will never take root, a surgical fad. From what I saw on TV it was very time consuming, almost slow motion. My other concern is that all attention will be on checking the bar coded items while perhaps slacking in other areas. I am a great believer in the human capacity to identify and solve a problem . I dont like the idea of OR nurses relying on this invention which if it malfunctions will bring serious consequences. Besides which, what exactly does this invention do?. It dosent make the surgical team more careful. It dosent stop other items being left inside the patient. It simply tells you if the entire set of sponges is removed. Lets face it my old brain has been doing that for 25 years. Personally I feel the only 100% guarentee of an item retained free patient is an x ray machine at the door of the OR room. Now thats a concept that has my vote!!!!!!!!!!!!

Marie_LPN, RN, LPN, RN · Mar 17, 2006

Don't like the idea.

Since i don't like it, and of others i work with don't like it, that's means we'll get it of course.

klb75 · Mar 28, 2006

Thank you all for the reponses!! I too first discovered this on the TLC channel. Last semester I encountered a woman who had a sponge left in her after a foot surgery and she ended up with a very large wound on her leg that was possibly going to be amputated. It drove me to further research Dr. Gawande's idea. I beleive that if the system can prevent the few mishaps that do occur then it is a system that should be considered.

tsommer74 · Mar 28, 2006

I agree that innovations and changes in nursing practice are important ways to help decrease errors, however I'm not sure that bar coded sponge counting will be one that is widely accepted. In my opinion, it sounds a little excessive and time consuming- not entirely practical in a real life setting. The pace of the OR (necessarily at times) is fast, and this seems like it would slow down and complicate (more machines = more malfunction) this pace.

The nature of being human is that we cannot eliminate errors 100%, but with consciencious nurses providing the counts, double and triple counting with a second pair of eyes, and simple aids like white boards to keep count and hanging bag separators to aid in counting, I think the accident rate should remain acceptably low. ....In fact, I'm curious about how often items (sponges) do get left in patients- do you have these statistics?

Amgal · Mar 30, 2006

Hi there! I read the info re: bar coding the sponges. Interesting idea but I don't think it is necessary. I have watched a number of surgeries and as long as the nurses line up the items to be counted in an orderly way the system works well. Time is of the essence in surgery. It is necessary to take the time to make the counts count! If the nurses were to use a bar code, what happens when the scanner doesn't scan properly (it happens so often in the grocery line). The cashier has to type in the bar code number and then press enter. For the grocery line it works, but for the surgeon, I don't think so. Again another example in the grocery line, sometimes the scanner accidentally beeps twice if you hold the lazer a little too long, then you get a double count. Can you imagine all the beeping and re-beeping to get the exact count? I do not think this is the way to go to handle the problem of left-overs in the body after surgery. Get the primary nurse to count and have another nurse count to confirm her original count. Keep it simple and quick. That's my advise! Anna Marie

klb75 · Apr 1, 2006

tsommer74,

According to the Department of Veterans Affairs less than 1% of surgical items are left in patients. In another nationwide study it was reported that 1 in 1500 surgeries resulted in sponges or tools being left in patients. Far too many in my opinion. These errors shouldn't be happening at all. Thanks for the reponse and the question.

klb75 · Apr 1, 2006

The department of Veterans Affairs reported that less than 1% of sponges and other items are in left in surgical patients. A nationwide study reported that 1 in 1500 cases resluted in sponges and other items being left in patients.