Count Procedures in OR - who does it?

[oneillk1]

Hi there

I am looking at how we do our surgical counts at my facility in New Zealand. We have two nurses circulating in OR and one of them does the count at the start of the procedure. Our current practice is that the same nurse must do the count at the end of the procedure too, regardless of whether they are in theatre. They may be called back from lunch for example. However any circulating nurse can add countable items (such as sutures or sponges). Can people tell me what their facility does and what is the best practice on this issue.

I get the feeling that we do it this way because that's how it's always been done.....not really a good enough reason!

Thanks in advance!:)

[suzanne4, RN]

What happens if the case goes longer and there is another nurse finishing the case?

In the US, the count is done by the circulator and the scrub. Who ever is in the room, and in that roll at the time, when counts need to be done. We would not hold up a case for the original person to come back to the OR.

We normally only have one circulator per case.

[Ferret]

In Australia the scrub and scout do it. It is preferred that tha same scout that started the count finish it, but not mandatory. How it is handled varies across hospitals, some hospitals are very strict about doing a changeover count when the scout is relieved, which seems a bit ludicrous, and of course there is always a changeover count when there is a change of scrubs.

Unlike the US, here the Scrub nurse, not the scout or curculating nurse is the senior nurse in charge of the theatre.

Ferret

[Marie_LPN, RN, LPN, RN]

Circulator and scrub count.

The only time that a relieving circulator must count is if the one they are relieving is going home. The one thing that annoys the crap out of me is that there are a few that repeat the phrase "we need to count" over and over, clipboard in hand, when it's OBVIOUS that i can't do it RIGHT NOW when blood is shooting to the ceiling and all over the floor.

[grimmy, RN]

i agree with marie - whenever i circ, i always say, "let me know when you're ready to count." there are times when it just isn't appropriate to count. of course, i don't let the surgeons decide that because half of them could care less, particularly when there are 2-3 of them closing the chest at breakneck speed. we do count all sharps with all relief scrubs. i hate being called an hour after i get home by someone saying "the counts are wrong, what did you do with....??" well, they were right when i left!! and, what do you expect me to do from here?? some days i wish we had another circ or scrub person, but most days i'm fine with just me and another team member.

[ortess1971]

In Australia the scrub and scout do it. It is preferred that tha same scout that started the count finish it, but not mandatory. How it is handled varies across hospitals, some hospitals are very strict about doing a changeover count when the scout is relieved, which seems a bit ludicrous, and of course there is always a changeover count when there is a change of scrubs.

Unlike the US, here the Scrub nurse, not the scout or curculating nurse is the senior nurse in charge of the theatre.

Ferret

What's a scout? Just curious, I find the differences between the countries interesting as regards the OR.

[Ferret]

What's a scout? Just curious, I find the differences between the countries interesting as regards the OR.

The scout nurse is our rough equivalent to your circulating nurse. They do the count, open the setups, act as patient advocates in assisting with positioning and ensuring that pressure area aid are used, etc. In most situations the scrub nurse has to be a registered nurse, while the scout can be a Enrolled Nuerse (EN) which is roughly equivalent to your LPN's.

Some hospitals train their EN's to scrub after a designated period of time as a scout, like a year, or a course for the purpose. In that situation, when an EN scrubs the scout must be a registered nurse. That is the only time here that the scrub is not in charge of the theatre. Most times, the scrub/scout swap roles each case and take scrubbing in turns. I was a EN/scout for a few years before I got my degree, and to me scrubbing is the best part of perioperative nursing... certainly the most fun, anyway.

Some posts on this forum suggest that your circulators assist the anaethetist in intubation and such, we have anaesthetic nurses or anaesthetic technicians to do that. Nurses here tend to either work Scrub/Scout or Anaesthetics/Recovery, with little crossover.

I'll see if I can dig up some old posts I did here last year that discusses the differences in a bit more depth for you.

Ferret

[Ferret]

I'll see if I can dig up some old posts I did here last year that discusses the differences in a bit more depth for you.

As promised, try How many RN's scrub? as well as What does "the circulator is in charge of the room" mean in your OR? and OR nursing QUESTIONS threads for more discussion. They're pretty cool threads to read, anyway.

Have Fun!

Ferret

[shodobe]

Scrub and circulator. As posted above if either are relieved there must be a sponge and needle count before they can depart. No instruments though.

[spyder]

I would like to say thank you to those of you who ask the person scrubbed in to count when its conveniant for them. Atleast during the case. The first thing I always count when we are closing is lap sponges and raytecs. When the doc brings them out of the patient. I tell the nurse. Hey I'm ready to count. I also keep the laps with me until we get through the first count. It is easier for me to pull the laps apart than to have a nurse don some gloves or use a sponge stick at that point. Most of the time I am done with the lap count before they have started the first run of the suture. I try to do it as quickly as possible that way if something is left in. Then we don't have to open the patient back up.

As for the rules on counting in the U.S. The count is done by either two R.N.'s (one being scrubbed in of course) or a R.N. and a scrub tech. Now the cool thing about that is. When I worked trauma there was a lot of times where we would do an urgent case, and the circulator would be busy with the patient. So I would count with the R.N. who was scrubbed in. It is still legit cause the count was initiated between a tech and an R.N. When it came to the charting I would just tell the circulater when she came in. Hey here is our count. If you want me to count when you guys are finishing up just page me.

As for relieving someone. I understand it needs to be done. If someone's shift is ending you can't expect them to stay, but it really sucks when you walk in to take over and the count is wrong before they leave the room. Then they refuse to stay and help find the missing needles.

[BonnieG]

I find it very interesting that the Australian system has the room charge as the scrub. Within the Canadian system, after 34 yrs of experience and I still love to scrub, I rarely get to. I am either running a room, a service or teaching. Maybe I need to retire here and move to the sunny shores of Australia. Then I can spend my declining years doing what I really enjoy.

Current practice within Ontario is that the room can have two RN's or 1 RN and an ORT/Scrub Tech(usually also an RPN). It is only for large cases that we may have a third person to help start a case. Rarely do we have three in the room for the entire case (two rooms may share one person, used for relief and change-overs). Only RN's circulate.

Personally, I will let my scrub know I am ready to start to count at her/his convienience. We try to get the sponges, needles and small items done as quickly as possible.

If either caregiver is relieved permanently, a complete count is done including instruments.

Nobody leaves if the count is wrong, either at end of case or change of shift, no matter what the time.

Policy says that the original persons counting in should count out, and for large,long or complicated cases,most comply. I wouldn't call someone back for the count on a breast biopsy. Common sense should still be used.

Hope that gives insight into the Canadian Standards, and common policy and procedures.

TTFN

[Ferret]

Personally, I will let my scrub know I am ready to start to count at her/his convienience. We try to get the sponges, needles and small items done as quickly as possible. If either caregiver is relieved permanently, a complete count is done including instruments. Nobody leaves if the count is wrong, either at end of case or change of shift, no matter what the time.

Policy says that the original persons counting in should count out, and for large, long or complicated cases, most comply.

We do all of the above, although the scout counting in is not that worried about being the scout counting out in many hospitals. Our ACORN standards state that three nurses should be in the room at all times that a patient is under general anaesthetic, the Scrub, Scout, and Anaesthetic nurse. Although as we have Anaesthetic Technicians here and on long cases the anaesthetic nurse/tech is not required to help the anaethetist, they often tend to do other things or relieve the scout for tea breaks, etc, so this standard is not always followed or hospital policy.

You are welcome to come retire here, any time. We love experienced periop staff :chuckle

Ferret