Count Sheet Questions...

[EvaJ]

On your Count Sheet, does your hospital require you to count Hypodermic needles? We don't, but I think we should.

Also, we count scratch pads, but not the Fred pads (used for Lap. surgeries). Don't you think that's strange, too?

I've only been working at this hospital for a couple months, so I'm just wondering what the routine is in other OR's.

[MamaCheese]

We count hypos. I'm not sure what a Fred pad is?

[ewattsjt]

fred is an acronym meaning fog reduction and elimination device.

policies with counts vary from facility to facility. my facility does not use scratch pads anymore. we do count hypos but not freds. i do find it interesting that you count the scratch pad and not the fred because if you look on the back of some freds, you will find a radiopaque strip. this is especially true for the ones that come with a bottle and a pad about the size of a scratch pad. not all freds are the same. some are like a moist wipe that come in a foil pack.

if you have a problem with the way your count is; then you should gather all relevant information like studies and sources and present it to management. i have gotten some policies changed in my facility by presenting the information in the correct manner with sound documentation supporting my argument.

i think the reason we do not count things like freds at my facility is because it is never placed through the trocar and if we do have to open; our policy mandates an x-ray on any emergency lap/open conversion.

i hope this helped somewhat.

[MamaCheese]

Gotcha:) We call them Dr. Fog and we do count them.

[RNOTODAY, BSN, RN]

Yes, we count hypos, but the policy does not say we must count Fred's,

[Rae83]

We count hypos, but I don't think everyone counts FRED....I do...I have always been told that "if the nurse wants it counted its counted, if the tech wants it counted its counted" So if you feel it is something that needs to be counted your tech should not tell you it doesn't need to be. I would rather take the two extra seconds to count something than chance it getting left behind just because "the policy says".

[OR male nurse]

We count hypos, but I don't think everyone counts FRED....I do...I have always been told that "if the nurse wants it counted its counted, if the tech wants it counted its counted" So if you feel it is something that needs to be counted your tech should not tell you it doesn't need to be. I would rather take the two extra seconds to count something than chance it getting left behind just because "the policy says".

I agree with you totally. I was taught to count the FRED. At the last place I worked it was counted. At the hospital I work now, they don't but I still ask for it to be counted. Regardless, you'll get ST's that will tell you "we don't count that here." It's close enough during a lap coly where it could go into a trocar hole.

[cdsga]

it is so frustrating why we still have a discussion on counts.

AORN standards and recommendations states broadly what you should count and also when you should count. When institutional policies are written concerning counts, they need to be balanced between detail and generic statements to allow for introduction of items that could possibly be retained. You can't state everything in the policy or you would have an inventory list longer that you can imagine.

We get so nitpicky with should i do this or should i do that.

Two things i know:

1) If there is a possibility that something could be retained--count it

2)The circulator should control what is counted. If you have a question about something count it. No arguing about it. Counting time is not a turf war, and that sometimes happens. The RN is the licensed professional documenting the count and is to ensure that the patient is cared for safely while unable to speak for theirselves.

Read your institutional policy, read the standards. If your policy is not easily understood, you might recommend that it be revisited and revised.

[cscott1]

I agree with CDSGA, if there is even the remotest possibility that something could be retained - count it. However, there needs to be a bit of common sense in the mix, it is difficult if not impossible to stuff an 18X18 lap sponge through a trocar!

[cdsga]

All count policies should list but not be limited to certain items.

You should count any item that can be potentially be retained during the case.

You have to use your common sense. Hypo's and freds are usually counted. Hypo's can even include spinal needles and angiocaths.

AORN Standards and Recommendations is your expert source and should be followed when your institution writes policies. If your institution does not count the things that you are accustomed to counting, you can count them anyway. Better safe than sorry.

[mcmike55]

Yup,,,,we go along with most of you.

Our OR counts, sponges, suture needle, hypos, blades scratch pads and FRED's.

I figure if the manufacturer put an xray detectable strip on 'em, they could be drug into the field.

I tend to agree with the "when in doubt count it" mind set.

Get in tune with AORN standard, and hospital policy.

I'm a big fan of following instincts, if something seems wrong, it probably is!!

Mike