Basic question about counting

nursinadream · Aug 30, 2008

Hmmm.....that's a good question. I sure don't have an explanation. Looking forward to some good discussion here.

Deb

openheartmary · Aug 30, 2008

By counting individual types of instruments we would know what is missing if something comes up short, that way we would all be looking for the same thing. It may be lunch time, relief counters, you're missing a towel clip, looking all over, original counter comes back and oh, yeah, the towel clip is holding the drapes. You would know exactly what was missing. Also, more manageable numbers. Ex: One allis out of eight vs. 75 instruments.

RNOTODAY, BSN, RN · Aug 30, 2008

OK, that makes sense for *towel clips*....those are instruments that might actually be off the field....but what difference does it make if your missing a Kelly or an Allis? Why do we need to know what we are looking for?

I think, count knife handles and small towel clips individually,and if everything is of the same relative size, count it alltogether. Do you know how much time is wasted following that stupid count sheet? especially when everybody calls things different names, "oh wait, oh yeah, those are these, and---...ughhhhh....I am getting aggravated just thinking about it....

I have 25 string instruments, if I dont have 25 at counting time, we look for it, and if we dont find it, we x ray. Why does it need to be harder than that??? :confused:

Scrubby · Aug 30, 2008

Interesting topic.

I guess if you know exactly what instrument is missing the surgeons might have an idea of where they used it last.

Most of the time when I know the tray well I count them individually it's not a problem. With some trays that i'm not sure what the instruments are because it's not my specialty area or that the tray is rarely used I just count the number. Probably not the standard but if there is 21 instruments on the tray beforehand, then there needs to be 21 at the end of the case.

I'm not sure what you mean by 'strings'. Are you referring to a clip rack?

NabiRN, BSN, RN · Aug 30, 2008

It really depends on what people in your OR are used to. In addition, the surgeon will ask you what instrument is missing before calling for x-ray. If you know the tray well enough, you probably have an idea what instrument is missing and it may not be necessary to count them separately. If something is missing in the beginning, you can get it before the case starts. It also depends on the team. If the scrub is not familiar with the instruments, the team should go through the count sheet to make sure you have everything for the case.

RNOTODAY, BSN, RN · Aug 30, 2008

Interesting topic.
I guess if you know exactly what instrument is missing the surgeons might have an idea of where they used it last.
Most of the time when I know the tray well I count them individually it's not a problem. With some trays that i'm not sure what the instruments are because it's not my specialty area or that the tray is rarely used I just count the number. Probably not the standard but if there is 21 instruments on the tray beforehand, then there needs to be 21 at the end of the case.
I'm not sure what you mean by 'strings'. Are you referring to a clip rack?

Oh sorry, "string", meaning, all the instruments that come racked together....all the ratcheted instruments.....

Nurse Salt · Aug 30, 2008

RNOTODAY, I'm sorry did you really say time is "wasted" using count sheets??? I'm sure the patient does not feel this time is wasted. Counting is a VALUABLE part of the process, anything done to avoid future health problems (and lawsuits) are not a "waste" of time. Knowing exactally what is missing may help narrow down where the lost item is. Besides, counting to 10 ten times is easier, faster, and allows for less error than counting to 100 once...

MamaCheese · Aug 30, 2008

I agree that's it's far easier & safer to count to 10 ten time than to count to 100 or whatever the larger number of instruments is. And it's far less confusing to know which instrument is missing and where it may have been used last. Our count sheets are set up to mirror the way the instruments are racked together. It's very easy to follow along with the tech as they count off instruments.

Fun2, BSN, RN · Aug 30, 2008

I have learned that many of the instruments can be grouped together...like "13 pick-ups".

Not sure about everyone's policy, but we don't count instruments for non-open cases. In that scenario, only an inventory count before/after by the scrub. (I think that's when....I'll learn more next week.) ha

I can see the point about the surgeons may know what they did with a lost Metz (for example), more than just a "lost instrument".

RNOTODAY, BSN, RN · Aug 30, 2008

When I say "wasted"......I mean the time it takes us to look for what the sheet SAYS is there, and to figure out what is actually there, and when the difference between each instrument is negligable,that yes, I do think that i am "wasting" time. After all, are we not concerned about efficiency? Of course I do not think counting is wasting time, I am just questioning something that doesnt make sense to me.... the process of it. And I still dont understand why, if you are missing an instrument, it will matter if it is a Kocher, or an Allis...its not like you can call out the instruments name , and it will say "here I am!!""

And I am also not lucky to work at an OR that gives us a count sheet that is exactly what the instrument tray contains. But that, is another issue entirely...lol

any more thoughts/ insight?

I have just been thinking lately, that in an environment that focuses so much on turn over time, efficiency, etc, that we (at least in my hospital) rely on systems and processes that are the complete OPPOSITE of efficiency, it seems. Dont even get me started on cases being booked by "CPT" codes......uggghhhhhh

Nurse Salt · Aug 30, 2008

When I say "wasted"......I mean the time it takes us to look for what the sheet SAYS is there, and to figure out what is actually there, and when the difference between each instrument is negligable,that yes, I do think that i am "wasting" time. After all, are we not concerned about efficiency? Of course I do not think counting is wasting time, I am just questioning something that doesnt make sense to me.... the process of it. And I still dont understand why, if you are missing an instrument, it will matter if it is a Kocher, or an Allis...its not like you can call out the instruments name , and it will say "here I am!!""
And I am also not lucky to work at an OR that gives us a count sheet that is exactly what the instrument tray contains. But that, is another issue entirely...lol
any more thoughts/ insight?
I have just been thinking lately, that in an environment that focuses so much on turn over time, efficiency, etc, that we (at least in my hospital) rely on systems and processes that are the complete OPPOSITE of efficiency, it seems. Dont even get me started on cases being booked by "CPT" codes......uggghhhhhh

I'm sorry if I came across as harsh, now I see where you were coming from... I really think it just breaks down to ease and the way the human mind groups things automatically. It is much easier to recognize and understand things when paired or grouped. I know you are looking for a black and white concrete answer, but this really is one of those areas that will unfortunately always be gray... Unless one night you happen to meet the man/woman who came up with the whole system and are able to ask him/her directly. In which case, please PM me and let me know what he/she says!