counting instruments

carcha

AORN's recommended practice says "Instruments should be counted on all procedures in which the liklihood exists that an instrument could be retained" (2003 Standards, Recommended Practices & Guideleines, p.223) # 4 under this recommended practice states how, that is audibly and with 2 individuals. Our hospital policy is written to include that instrument counts be done in cases where body cavities are opened, i.e., brain, peritoneal, bladder, uterus, chest, for example.

How in earth can anyone in this day and age NOT make an effort to follow a recommended practice prescribed by their national specialty organization?

Paula

carcha, your asking for trouble if you don't go by what chartleypj says. I remember an item in the news not to long ago about a patient that had a ribbon left in them. I swear it was from England. Mike

Wow, not counting??? Now that is just crazy. I work OB and we count a total of 4 times for a c/s (two instrument, two item counts) Just unthinkable, because it is very easy to leave something behind. I would follow AORN standards like chartleypj recommends. We had a hospital sued in my area for leaving a 1 1/2 inch wide maluable in a pt...how they missed that one I just cant figure out. Found it when the pt. tried to fly to visit some relatives and couldn't get past airport security.

yeah I knew I was right. I've spoken to my friend to let her know how vunerable she is leaving herself by being bullied into not doing a count, shes young and dosent want to upset her head nurses . believe it or not, she's under the impression that if a case went to court, her defence for not counting instruments, ie the head nurse told me so would hold up. the thing is that, where the girl works, the head nurses dont scrub. SO , another question, what if the particular facility u work in dosent have a policy on counts. is she covered?

Hi, I'm a nursing student and just the other day I was in surgery watching a lumbar spinal fusion during my neuro/ortho rotation. When the primary surgeon was finished with the fusion, the secondary Dr. was closing up the incision. The circulating nurse discovered a sponge missing (the COUNT was short), told the scrub nurse and then the Dr. stopped what he was doing (getting ready to pull the deepest set of sutures closed) and hunted for almost 1/2 a minute before discovering the sponge. Wow, wouldn't that have been a disaster if not caught. All in all, it didn't seem THAT time consuming to make the initial count and the last count when the surgery was finished so why would anyone want to take the chance! :stone

carcha,

Is that to say the hospital your friend works in hasn't any policy on counts? Somehow that just doesn't seem possible in this day and age where patient safety first is critical.

Paula

Don't they have to answer to AORN standards??? I thought that these associations were in place to help give some sort of national standard for accredidation by JCAHO???

my friend works in a hospital in europe, not the usa or uk. however I know shes not happy not doing an instrument count, and I can only imagine the pressure she and others feel when they finish a case worried the they may have left an instrument inside and praying to god they havent. How in this day and age can a head nurse be allowed to get away with it. What is her rationale?. I'm so puzzled by this one

I;m a new grad, but we are required to do a baseline count, a count when we are being relieved by someone, count new instruments/sharps when they are added to the field, count prior to wound closure and a final count

Originally posted by shodobe

carcha, your asking for trouble if you don't go by what chartleypj says. I remember an item in the news not to long ago about a patient that had a ribbon left in them. I swear it was from England. Mike

Mike, the same exact thing happened a bit closer to home--Washington state. Had a malleable (ribbon) left in during a laparotomy. So weird to imagine that happening, since a ribbon is most commonly used like a visceral fish--while CLOSING. Can't see how it could have been left in, unless the patient was REALLY obese. Plaintiff (patient) got a huge settlement.

Originally posted by shodobe

carcha, your asking for trouble if you don't go by what chartleypj says. I remember an item in the news not to long ago about a patient that had a ribbon left in them. I swear it was from England. Mike

Mike, the same exact thing happened a bit closer to home--Washington state. Had a malleable (ribbon) left in during a laparotomy. So weird to imagine that happening, since a ribbon is most commonly used like a visceral fish--while CLOSING. Can't see how it could have been left in, unless the patient was REALLY obese. Plaintiff (patient) got a huge settlement.

I hate doing freakin' instrument counts, and I ALWAYS know what is on my mayo at any given time, because I keep the very minimum up there, and I only put instruments up in pairs--not odd numbers--and I placece whatever is no longer being used into a soak pan of water--so it is clearly visible, and also accessible, in the rare event it is needed again.

However, now that newer scrubs tend to put ALL their instruments needed for the entire case on their Mayo stands at the beginning, and keep adding more instruments TO, not taking away, from the field, I think that instrument counts have become a necessity. Too bad, because in the '70s and '80s no one ever did instrument counts, and I never heard of any retained instruments, EVER.

You know what you DO have to be careful about? Surgeons that put a blue towel in the pelvis. This is often during done during radical prostatectomies, and is a practice that I am highly uncomfortable with--you have to write it on the count board and make SURE it is out before closing. Usually only urologists do it, and it seems to be done about everywhere I have ever worked. No big deal, I guess, as long as you are careful to CYA by making sure that towel really DOES get removed.

It is really strange to hear from people how they just implemented a count in their OR in just the past few years. I have been doing this since 1977 and the hospital where I have worked has always had a count policy. I always assumed this was the standard only to find out it really wasn't. Each hospital had it's own policy to this affect. I think the majority of hospitals go by AORN standards now and we have to remember carcha is from the UK and I was wondering if they use these standards like we do. I also hate to count but it is second nature and it can go very quick especially if you lay everyhing out for the circ to see. You know the surgeon is going to want your complete attention when they close so the the circ will have to count pretty much for you. I prefer to count myself needles and sponges and will live instruments for the circ to count. I know this isn't the right way, you should devote your intire attention to the count but in reality the surgeon isn't going to go sit down while you count! Also you do have to watch these guys, they can be very sneaky when it comes to putting things in the abdomen without telling you. I make it a habit to announce loudly enough for the circ to hear so they can write it on the count board. We also have a poilcy that we do not have to get an order from the surgeon for an x-ray if something is missing. Small vascular needles are usually the only thing we do not waste time looking for because you can't see them on film anyway. Got to go now I have a Gamma Nailing to do in a little while. Mike