Horrible thing happened in O.R yesterday

[Scrubby]

This is just one of those nightmares that you never think will happen to you..

I was scrubbed for a lap fundoplication yesterday. Haven't done one in a while, and found it a bit hard to keep up doing the suturing. A suture was missing when i did the final count. The surgeon was convinced it was not left in the patient. At the time i didn't believe it was in the patient either, i believed at the time that i had lost it on my set up, or it flung off the laparoscopic needleholder (which can happen because they release quite violently sometimes). We searched high and low, got the senior RN in and just keep looking for it. I believed it was my incompetence in handling sutures and the surgeon quite readily went along with it.

As per protocol we recommended an on table x-ray. This was suggested several times by myself, the scout nurse, the floor senior. the surgeon said do it out in recovery, the floor senior agreed with this. We all went home believing it was not in the patient.

Found out today at work that the suture WAS detected on the x-ray. They are now waiting to be reopened to have it removed.

At the moment i am so mad for doubting myself. Why should i automatically assume that i lost the damned thing?

I am also disappointed in myself for not keeping a more vigilant track of my sutures. I really should have known if i didn't get one back before handing up another.

I am furious with the floor senior RN for giving in so easily to the surgeons demands to x-ray patient out in recovery.

And i'm mad at the surgeon for assuming it was my incompetence not his that the suture count was incorrect and for not doing an x-ray on the table

I have been told that i'm not to blame for any of this. I still feel so guilty though. Now the poor patient has to have another procedure because of all of this.

And to be honest i'm quite worried here. We are doing the same procedure tomorrow with the same surgeon. He is known for being a nasty piece of work and am concerned about what will happen. I'm still emotional about all of this and don't want to lose it and scream my head off at him.

[ladylabor]

WOW Well the best thing to do when confronted with this doctor is to remain professional. You have obvious professsionsalism with the situation. I am also disappointed in the nurse who should have made it her first pirority to be the patient's advocate and protect the patient by following the hospital's policy. Thing of it is that dr. often find themselves at fault and don't want to appear incompatant and take it out on someone eles, often scrub techs, nurses ect. Well Good luck with the next case. Be completely confident in your self

[Virgo_RN, BSN, RN]

I'm sure you must be feeling sick over this. I hope all goes well tomorrow. I would probably take the high road and just remain professional, as suggested by the previous poster. Good luck tomorrow!

[Marvie]

I know that you might feel this was the worst thing to have happened, but think of it this way...they did find it in the patient and you did say that you believed that an xray should have been done before leaving the OR, and the good news is this person will have it removed. Now, please don't beat yourself up because although we don't want things like this to happen and work to avoid it, they do in fact occur nonetheless. It was found and it will be removed, so the patient will not be going home with it in them. And although mistakes do occur, I am sure that the next time you scrub, this won't happen because of how it made you feel. I know that I have been in that type of situation, as well as many others and so we can only learn from mistakes and not repeat them. Blessings to you and keep your chin up.:flowersfo

[zenman]

Surgeon was informed about count and failed to follow protocol. He's got to tell patient, "I left it in there."

[snowfreeze, BSN, RN]

When I know there may be a confrontation I run different scenarios through my head that way I am prepared with a calm response to just about anything bizarre the person in question may toss at me. I actually laugh at myself when I do this then when things become tense and I have an appropriate and calm response I am glad that I did my little mental preperation beforehand.

[TazziRN, RN]

Scrubby, if he comes at you after having been proven wrong, then he would deserve absolutely whatever you threw at him!!! It's not like you tried to make him look bad, you tried to keep him OUT of trouble and he refused. Therefore it is now on him.

As for doubting yourself and thinking you made a mistake, you're not infallible either. The difference between you and him is that you suggested ways to remedy the situation and he blew you off. Because of that it now makes HIM look bad.

My opinion: I would rather you blame yourself and find out otherwise, than have the "I couldn't possibly have made a mistake" attitude because then you would be no better than Dr. God.

[cloister]

Hey, you did your best and you were trying your darndest to follow policy and procedure on the missing suture. Unfortunately, if the surgeon doesn't see fit to follow protocol, guess what? Said policy goes out the window. I don't see what else you could have done, and please don't flog yourself for handing off another suture before he handed one back. That happens, and that's why there is a policy in place, which he chose to ignore.

I work nights, and we have a lot of the same stuff happen - you encounter a problem at 0200, call the MD, he wants the problem to just go away until 0700, doesn't want to order the CXR/ABG/whatever that he might then have to treat. I had it happen to me two nights ago, and I'm still feeling bad about it. I know, however, that I was right about what I was seeing and that I suggested the right course of action for the patient - to two MDs. Couldn't get it ordered, despite stressing my concern. Guess what? She wound up on the therapy at 0900 that morning after the NP walked in and ordered it. Unfortunately, I was about 7 hours too early in reporting it!

You did your best, and if nothing else, that surgeon now knows that you are the competent one. My guess is that he won't have a lot bad to say to you and might actually be pleasant - because this one is clearly on him.

Chin up. You can be my OR nurse anytime.

[ebear, BSN, RN]

Under NO circumstances should the patient be taken to the PACU to find the needle,sponge, instrument or anything else that was reported missing on xray. The doc was told by the nurses that the item missing could not be located. None of the docs think that it could ever be their fault, and a majority of time it is! This results in another surgery by the patient, increase medical bills, etc. and this incident should be reported to risk management at once. The hospital should "eat" this extra unnecessary expense and hope that the patient does not file a lawsuit, as this incident falls well below the standard of care for surgeons. A smart NM would have said "Doctor X, this patient is not being extubated or removed from this table until Xray is done and read by a radiologist. If you feel that you must scream and stomp your feet, then be my guest in the doctor's lounge. We'll have the radiologist call you in the doctor's lounge after he calls us!"

[TiredMD]

None of the docs think that it could ever be their fault, and a majority of time it is!

"Majority" is a little strong.

[ebear, BSN, RN]

Well, in my particular hospital, the staff is so anal about counts and do a damn god job in being thorough about them. It is usually the surgeons who say "WELL, IT'S NOT IN HERE!!" On xray, There it sits--right where he placed it! "Oh! I forgot about putting that there to mark so and so"...

In my hospital, anyway, the surgeon cannot leave the OR until item is found, and the sterile field remains set up and not contaminated. Often the docs are angry about this policy, but it saves a lot of time and expense, as well as subjecting to patient to more apprehension and another induction.

[TiredMD]

It is usually the surgeons who say "WELL, IT'S NOT IN HERE!!"

The smart ones say, "Shoot an xray and document that it's not in there" to cover themselves.

I'm not saying they don't get grumpy about it, I'm just saying that I've seen a lot more negative on-table xrays than I have left-in needles.