How many times do you count instruments?

[scrubulator]

After a big open case my new hospital only counts the instruments only once at the end-when they start to close the fascia (1st count). I think this is unsafe because a instrument (mosquito, probe,malleable, kelly, etc.) can get lost after a first count and somehow end up in the body. If you only count the instrument once at the end, you still have another layer to close so how can you truly say that you are 100% certain that no instrument is in that body?

[[My old practice was that once you start to close, you count all instruments but keep a separate tally of how many instruments are still in use. Then, after the fascia is closed and you are on skin (the final/last/resolution count) you ensure all the instruments on that separate tally are still present. I have also heard other hospitals, doing an instrument count all over again. ]]

So I am tallying up other places, how many times do you count instruments at the end of a open case? And, is that really enough?

[pixiestudent2]

We have the same policy, we count instruments once... Except we count the instruments used to close again during final counts. Like we make sure the malleables are back, and mosquitos or anything else they use at closing.

[Rose_Queen, BSN, MSN, RN]

We only count instruments once at the end, with the exception of surgeries where there's an open cavity within a cavity such as open uterus procedures and open bladder procedures. My question is- when are you counting instruments that you're concerned about them being left behind? We don't count until the sutures are goin in, and the incision is closed before the count is completed. We do keep track of any instruments that have already been counted that are passed back up before the layer is completed. We also hold off on counting certain instruments, such as rubios when closing a sternum, until we have finished using them.

[Crunchtime]

Depends on the hospital policy. In our facility, we count 3 times; before incision,when cavity closure starts (open abdominal cases), and skin closure. As with CVOR, for valve cases, we count 4 times (before incision, valve closure, thoracic cavity closure and skin closure). As with CVOR it might sound a lot but it isn't really once u get to know the tray. It's fairly routine but take note, even if you know your tray well, u still have to look at what your counting and compare with the count sheet (ALWAYS!). You'll never know if there's an extra mosquito added mistakenly by SPD in your tray. So be very careful.