Hospitals who count all instruments on all surgical cases

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Specializes in O.R. Nursing - ENT, CTC, Vasc..

Yes, I am asking, ALL cases?  Even cataracts.  Is your hospital counting everything that touches the patient?  Ours is making us.  

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Specializes in OR, Nursing Professional Development.

Nope. Instruments only when entering a cavity.

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Specializes in ICU, Trauma, CCT,Emergency, Flight, OR Nursing.

That is absolute madness and definitely not helpful in terms of efficiency or improved workflow/ productivity . Only count instruments on on big/open belly and chest cases. In our ALIFs , we do a mandatory XRAY before the final count . 

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Specializes in O.R. Nursing - ENT, CTC, Vasc..

Thanks for the replies.  I agree, it sure does take up time.  We're trying to standardize a "flow" so we can try to stay within our turnover times.  It's stressful.  

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Specializes in O.R. Nursing - ENT, CTC, Vasc..

No surprise that no other OR nurses are replying that their facility requires instrument counts on all cases, even superficial cases.  VA nurses don't have to reply 😉

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Specializes in RN CNOR CRNFA, LNC, AACS, LLC.
Rose_Queen said:

Nope. Instruments only when entering a cavity.

That is incorrect. All counts for ALL procedures ,, especially when a cavity has been entered! WTH? Standards of care. Ever heard of those?

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Specializes in RN CNOR CRNFA, LNC, AACS, LLC.

taking an x-ray at the end of the case, INSTEAD OF KEEPING UP WITH ALL COUNTS BEFORE, DURING, AND AFTER CLOSURE OF THE LAST CAVITY, IS NOT EVER< NOR HAS IT EVER, BEEN ACCEPTABLE PRACTICE. All counts means: needles, sponges of all sizes, ie: q-tips to laps, implants and instruments. Unnecessary radiation exposure can be dangerous to patients, especially CHILDREN.  Only LAZY , UNPROFESSIONAL, UNSCRUPULOUS, INSIDIIOUS scrub techs and nurses would pull such a stunt and should lose their jobs. This practice should be reported to JOINT COMMISSION, MEDICARE and MEDICAID FEDERAL AGENCY and include ALL ACCREDITATION organizations. they would jerk their accreditation and shut down the facility. Licenses and certifications would be taken away. THIS IS NEVER ACCEPTABLE PRACTICE ON ANY LEVEL AT ANY TIME FOR ANY REASON. WE HAVE STANDARDS OF CARE FOR A REASON. END OF STORY. If anyone does not wish to uphold these standards, they are in the medical profession for the wrong reasons and need to leave. 

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Specializes in OR, Nursing Professional Development.
Avonlea said:

That is incorrect. All counts for ALL procedures ,, especially when a cavity has been entered! WTH? Standards of care. Ever heard of those?

Hello @Avonlea and welcome to allnurses!

AORN guidelines state

Quote

AORN recommends that perioperative personnel account for instruments during all procedures in which there is a likelihood of retaining an instrument.

Source: https://aornjournal.onlinelibrary.wiley.com/doi/10.1002/aorn.13804

If you look at this graphic from the article, while the box for instruments is marked as to be counted, the footnote clarifies "in all procedures for which the likelihood exists that an instrument could be retained (See Recommendation 5.1) and all procedures in which an open body cavity is entered (See Recommendation 5.2)"

aorn13804-fig-0001-m.thumb.jpg.6d4dedcdd8e66dcf8036840fb115d575.jpg

This does not equate to requiring an instrument count on all procedures. Of course, if one's facility policy requires an instrument count on all cases, that policy should be followed. I have never worked in a facility that required instruments to be counted on all cases.

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Specializes in RN CNOR CRNFA, LNC, AACS, LLC.

and I've never worked in a facility that doesnt require an instrument count on all procedures, at the very least, beginning and ending for minor procedures such as lacerations, as long as they are not GAPING . It's just sound practice, and AORN RECOMMENDATIONS are just that. RECOMMENDATIONS. Sloughfulness, laziness and irresponsibility has no place in the O.R., on any level. CHOOSING NOT to think and reason independently within your scope of practice, and just relying on Recommended Practices set down by AORN alone, won't save you in the court room. But perhaps the Culture of Excellence I was raised in, is different from the one you come from. Irrespectively, our patients we have sworn to protect and serve,  deserve our best. I certainly give it to them and offer NO EXCUSES.

Additionally, I see where your document from AORN shows only an INITIAL Instrument COUNT being done for any of those. what would be the point in counting instruments at all if there wasnt a final count done to reconcile it is correct?   ....see, thats where critical independent thinking comes in.....

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