counting instruments

chartleypj · Sep 24, 2003

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

shodobe · Sep 25, 2003

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

acuteobrn · Sep 25, 2003

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.

carcha · Sep 26, 2003

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?

IowaKaren · Sep 26, 2003

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

chartleypj · Sep 26, 2003

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

acuteobrn · Sep 27, 2003

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???

carcha · Sep 28, 2003

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

Chrislynn2003 · Oct 1, 2003

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

stevierae · Oct 11, 2003

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.

stevierae · Oct 11, 2003

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.