How does your institution count multi panel procedures?

[tariett]

I am interested in knowing how other institutions count on multi-panel (more than one surgeon and procedure) cases? Do you count each panel separately or combine all panel instruments and softs? Do you count after each panel or wait until the end of the case?  If you count after each panel, what do you do if there is a miss-count identified? 

I really appreciate everyone's responses!

Thank you,

Tariett

[Rose_Queen, BSN, MSN, RN]

It depends on what the two procedures are. If it’s all through one incision, one count. So mastectomy by general surgeon followed by tissue expander placement for future implant reconstruction by plastic surgeon would be one set up, one incision, one count. (Bilateral would have a closing count for each side). 

If we have an open abdomen case and a fracture case, we would have one set up for the abdomen, counted separately. Then that set up would be torn down and the fracture would be a second set up with a second count. 

We would document each count and follow policy for miscount at the time it is identified. 

[tariett]

Thank you for your response. 

How would you handle a case for example that has an abdominal incision followed by a flap? Where the initial incision is extended by a second panel/surgeon? 

Thanks!

[Rose_Queen, BSN, MSN, RN]

If the first incision is utilized in the second part of the case, it's one set up one count. If it were to be closed but we're using the same set up, it would be the same count with closing counts for the abdominal incision.

[RickyRescueRN, BSN, RN]

Two different operative sites, two different closing counts (first and final for each individual site)