Basic question about counting

Specialties Operating Room

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I know this is going to sound really stupid, but I really have trouble with this concept.

In re: to counting instruments. You are counting a string. You have Allis, Kochers, Kellys, mosquitos. What difference does it make how many of each there are? We are counting to make sure nothing is left. If something is missing, why do we *need* to know if is a Kelly, or a Kocher, for example? They both will show up on an xray , and if one item is missing, we will use the same methods to look for it, right?

Why cant we count strings in one complete set, and retractors by the set? Does it really matter if your missing a large Richardson, or a medium Deaver? If your missing an instrument, your missing an instrument, and you do the same thing regardless of what is actually is.....so why do we have to waste all that time?

Be nice, I told you it was basic......lol:rolleyes:

Specializes in Operating Room.

I have worked in both kinds of OR's. Those that counted the whole tray together, and those that separated the types of instruments out. I will say from my perspective, it is easier for me to find a missing instrument when I know what I'm looking for. This is really the case in procedures where you have more than one tray.

I say this not to be snotty. You seem like you are going to be a good OR nurse,:nurse: but I think you should pick your battles. Most places do the counting by separating the instruments out. The one place I worked that did it the other way was in the process of changing it, because it just wasn't working.

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Specializes in Operating Room.
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".

When I did laparoscopic cases, we'd do an initial instrument count, just in case we had to open during the case. This saved us from having to scramble to count when the surgeon was barking for the scalpel.

Obviously, if we didn't open, we just counted sharps and sponges for the closing and final count. The argument could be made about why we were counting sponges, but we were told we had to.:rolleyes:

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Specializes in NICU, ER, OR.

Witchy, Salt...

Fair enough..... thanks!!;)

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Specializes in Med-Surg;Rehab;Gerontology; Now OR.

That practice is what exactly drove me crazy on a travel assignment. I find it bizarre just to count all instruments and not grouping it together. By the time you count up to 90+ or 100+ and something's missing, you have to do it all over again all the way up. That is just ridiculous. And as everyone said it is important to know what you are looking for.

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Specializes in surgical, emergency.

When we "got back into" counting instruments, one of our Scrub Techs really did a nice job getting us on the right track.

Over the years, our baskets grew way too large, many instruments in there because "we might need it", which was true, but many times was we used it in 1995, and "might need it again".

So we thinned the baskets out, with the docs input mind you, then adjusted the number to evens, such as 14 hemostats, 8 kelly's, etc.

That way, doing a quick pre-count kind of thing, if we had an odd number, we had a head start on problem solving.

Some of our smaller baskets, that we augment with our main Heinz, may have only 8-12 instruments in it. What I like to do is count each individual instrument, the count the total of that particular tray when closing. If our total is off, we'll back track, but because of the initial count, will at least know what we are looking for.

Our docs, for the most, have been very supportive of counts, we have had some complaints, and are working on methods so that we all get what we want.

The journey continues..................

Mike

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When we "got back into" counting instruments, one of our Scrub Techs really did a nice job getting us on the right track.

Over the years, our baskets grew way too large, many instruments in there because "we might need it", which was true, but many times was we used it in 1995, and "might need it again".

So we thinned the baskets out, with the docs input mind you, then adjusted the number to evens, such as 14 hemostats, 8 kelly's, etc.

That way, doing a quick pre-count kind of thing, if we had an odd number, we had a head start on problem solving.

Some of our smaller baskets, that we augment with our main Heinz, may have only 8-12 instruments in it. What I like to do is count each individual instrument, the count the total of that particular tray when closing. If our total is off, we'll back track, but because of the initial count, will at least know what we are looking for.

Our docs, for the most, have been very supportive of counts, we have had some complaints, and are working on methods so that we all get what we want.

The journey continues..................

Mike

We used to have main sets and then specials for each doc. So if one used a particular type of scissors or needed 12 allis for example that was in their set. We would keep the main sets as lean as possible.

We counted individual types of instruments. I can easily see losing count and then having to start all over. Especially when closing. To me its easier to do 12 criles then get interrupted.

David Carpenter, PA-C

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Okay so You have 70 instruments in tray 1 and 30 instruments in tray 2, but your break person put 8 things in tray 2 that should be in tray 1 plus an additional set of stats were opened that throws your count off more.

Now if these trays are broke down into Allis, mosquito etc... it's an easy fix, if it's some inventory deal game over.

Efficiency often over rules safety even inadvertently. We as Nurses hold the trump card which is advocating patient safety and I can guarantee if your need to slow down is that, You'll never be chastised.

There is a limit though, Some nurses stick to there guns and count every item no matter the case. Your not going to loose an allis doing a knee scope.

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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:

I don't know about in your OR but in ours towel clips aren't the only instruments that could possibly be off the field. We are not encouraged to flash many instruments so there may be any type of instrument that has fallen, or a pair of scissors and needle driver used prior to beginning the case, etc. etc. that are no longer on the field. We also use a variety of instruments (mostly kellys but really any clamp can work) to secure cords/saddlebags, etc. to drapes during the case. I have never had an instrument that was "missing" actually be in the patient but more often forget that something is off the field or on a drape...its easier to figure out what your looking for if you've counted the instruments by type instead of total number. It also helps you know exactly what you have so when the surgeon asks for that 7th kelly and you only had 6 to start with you can maybe offer a suggestion for something else they could use or know you need to get more.

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I don’t know who came up with the way we count but I can say that it makes it easier if a doc is needy to go by instrument groups. If they need more sutures or something that makes one defer from counting, it is simply picked up at the last checked instruments (no guessing on where you were or making the surgeon wait until a count is completed). Also if it is done on something like a C-section and you have to count when the uterus is closed; it allows for instruments to come and go into the abdominal cavity without the mistake of recounting an instrument.

I can say from experience that it is easier to find a pair of scissors if you know that it is what you are looking for (remember that the doctor cut the drapes and threw a pair of scissors off?, One peon or hemostat went off field with the baby, The doc used a hemostat to turn the pressure up while you were working with anesthesia, etc…). To simply say that one of something is missing gives no one a hint on what it could have been used on.

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Specializes in NICU, ER, OR.
I don't know who came up with the way we count but I can say that it makes it easier if a doc is needy to go by instrument groups. If they need more sutures or something that makes one defer from counting, it is simply picked up at the last checked instruments (no guessing on where you were or making the surgeon wait until a count is completed). Also if it is done on something like a C-section and you have to count when the uterus is closed; it allows for instruments to come and go into the abdominal cavity without the mistake of recounting an instrument.

I can say from experience that it is easier to find a pair of scissors if you know that it is what you are looking for (remember that the doctor cut the drapes and threw a pair of scissors off?, One peon or hemostat went off field with the baby, The doc used a hemostat to turn the pressure up while you were working with anesthesia, etc...). To simply say that one of something is missing gives no one a hint on what it could have been used on.

:banghead: but an item is still missing, so if we cant find it, take an xray!!!!????

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If an item is still missing, yes, take an x-ray. The point of grouping is to give you somewhere to look first instead of x-raying the patient then find that it was passed off or something like that. All instruments have a use and it eliminates looking in places where it wouldn't have been used.

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Bottomline, POLICY dictates where, what, why, when, and how you count. Period. In our case CSR/Sterile Services set up our 'system' of counting instruments so it became more of an inventory-management tool than safety issue...with less than positive outcomes. Focus was on to whom to point the finger when sets came up short or were not assembled (or returned) in an orderly fashion. It did not help that the Materials Manager would entertain NO input from the OR and, indeed, eventually became the OR Supervisor in spite of the fact that she had zero nursing or, even, any OR experience whatsoever. She was a Data Processor hired to program the newly installed computer system and as such was, or became, in complete control of the OR. And we let it happen because everyone was too busy or too tired or too pig-headed to take command of our destiny and insist upon being involved. Duty called and we hung up!

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