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Discussion

count sheets

where are instrument count sheets put in your or's. On the outside or in the tray with the instruments.

joe

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Mourkoth said:
Well, I'm saying it!! I won't mention any names, but I work at one of the two level one trauma centers in the state of Oregon. We never count anything from the tray on any extremity case. We, as responsible nurses, count (to ourselves) the smaller things that go into a patient (only on large abdominal cases) to make sure that they come back out. If there is any question at all from anyone on the operative team, we simply get an x-ray. It is not the hospital policy to count instruments. I've been there for eight years and I've never heard of "instrument" ever staying in a patient beyond the end of the case. I'm not saying that it is probably a good idea as a scrub, to be accountable of your instruments. If you have to count them just like laps and rays, then by all means count them a dozen times. All I'm saying is that my hospital doesn't require it.

And I challenge anyone to find the famous quoted standard from the AORN that says that all instruments must be counted. If you can come up with this, I will gladly show it to my superiors, and petition to change the current policy.

From the 1999 guidelines (I am pretty sure this is unchanged in 2004):

Quote

RECOMMENDED PRACTICE III

Instruments should be counted on all procedures in which the likelihood exists that an instrument could be retained.

Interpretive statement 1:

Instrument counts should be taken

* before the procedure to establish a baseline,

* before wound closure begins, and

* at the time of permanent relief of the scrub person and/or circulating nurse.

When additional instruments are added to the field, they should be counted when added and recorded as pan of the count documentation.

David Carpenter, PA-C

I know this is an old post, but here is one of our c-section count sheets (we actually count after each layer, which is not reflected on this sheet).

countsheetc.jpg

This is just my opinion, as a nurse who usually circulates and scrubs on occasion.

I feel it's my responsibility to make sure nothing is left inside my patient. Period. I don't care about requirements, or standard practices, or surgeons' time constraints. I don't care about ******* off the cranky circulator (when I'm scrubbed) or scrub (when I'm circulating). That's not my priority. My patient is my priority. I make sure everything is counted, if there's any possibility it could end up inside the patient. And if there's any doubt about the final count, I'll ask for an xray. My experience so far is that I've gained respect from my coworkers for my stance. I don't care about that though. I just want to make sure I've done the best that I can to care for my patient.

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