Incorrect count..

[GadgetRN71, ASN, RN]

Hi-question about counts. When you go to do a count and the tech has extra items that are not documented on the count sheet, that is still considered an incorrect count, yes? I was always told that you arent off the hook even if you have extras because you really have no way of knowing what they started with, especially when you didn't start the case.

I'm anal about counts and we have a good policy in my facility where people are encouraged to speak up..I told the surgeon and he called for an xray anyway even though it was a supposed overage. Tech was mocking me but she's a piece of work anyway.

I went to look this up (online, AORN etc) and really couldn't find anything specific about it. I don't know why I'm second guessing myself...

[Rose_Queen, BSN, MSN, RN]

Wrong count is a wrong count, whether it's too much or too little. There are those who say that the only way to make sure nothing is left in the patient is to x-ray everyone- counting is done by humans and humans aren't perfect. Personally, I don't think it needs to go that far, but if there's too many of something, the same procedure should be used if there isn't enough. I've even had to do an x-ray for a needle where the surgeon pulled too hard on the suture, and the needle went flying across the room. None of us could find it, and even though we all knew it wasn't in the patient, we still followed policy and got the x-ray. I also like having standardized sets- I know if we're doing a laparotomy, there will be 20 kelly clamps, 8 babcocks, etc. regardless of the surgeon. Always remember- it's the patient that counts, and you did the right thing for them.

[GHGoonette, BSN, RN]

Question from someone currently testing the waters in OR, with an eventual goal of scrubbing; I know extras are frequently required for certain procedures, and these are obviously not on the standard checklist. What do you suggest as a means to prevent probably unnecessary X-rays?

I've observed some of our scrub staff during lengthy ops where extras were called for, but they don't have a specific recording system when these are utilized, and rely on memory when counting them. It occurred to me that the circulating nurse can record used extras as they are opened so that they can be included in the count, with their own accompanying document.

[Rose_Queen, BSN, MSN, RN]

Question from someone currently testing the waters in OR, with an eventual goal of scrubbing; I know extras are frequently required for certain procedures, and these are obviously not on the standard checklist. What do you suggest as a means to prevent probably unnecessary X-rays?

I've observed some of our scrub staff during lengthy ops where extras were called for, but they don't have a specific recording system when these are utilized, and rely on memory when counting them. It occurred to me that the circulating nurse can record used extras as they are opened so that they can be included in the count, with their own accompanying document.

They don't record what they give and rely on memory? Well, that's one way to get a correct count- I'll just say we should have what we do have:rolleyes:. What happens if someone gets relieved?

We have a sheet, with boxes divided in half, so that we do our initial count, add something, write it in the first of the half box and the total in the second half. We also have several blank spaces to write in something that may not be on the preprinted sheet.

[Scrubby]

Question from someone currently testing the waters in OR, with an eventual goal of scrubbing; I know extras are frequently required for certain procedures, and these are obviously not on the standard checklist. What do you suggest as a means to prevent probably unnecessary X-rays?

I've observed some of our scrub staff during lengthy ops where extras were called for, but they don't have a specific recording system when these are utilized, and rely on memory when counting them. It occurred to me that the circulating nurse can record used extras as they are opened so that they can be included in the count, with their own accompanying document.

We have similar issues on our OR record sheet. For example, if we were to open another pair of scissors during a case there is nowhere to record these items.

If the count is incorrect then you follow the standards. Always, always CYA

[Tiffany, RN, BSN]

An incorrect count is an incorrect count. I shall never forget the TAH I was doing when I ended up with 1 too many forceps at the end of the case. One was hiding in the tray and neither the tech nor I saw it during the initial count:banghead:. We did an x-ray just in case. Its always good practice to be on the safe side because who was to say that we didn't have 2 extra forceps and 1 was left inside? Ya never know. So CYA!

[SandraCVRN]

We just write extras down on the side of our regular count sheet. long scissors - 1, deavers -3, etc

[canesdukegirl, BSN, RN]

If you are adding something extra that is not included in the count sheet, OF COURSE you should write it in! And I will do an x-ray if the count is off, no matter what. This is being safe, being a patient advocate, and is the standard of care in the OR. Good question. I like the responses given:)

[Sister Fox]

It's been a few years since I actually worked in theatre (4 actually!) but when we got extra items out, the packet was fixed to a clipboard kept especially for that purpose and kept on top of any trays for said extras. Items were then counted to the packets and trays. Easy!