Incorrect counts at shift change

TakeTwoAspirin, MSN, RN, APRN · Apr 25, 2012

Hmmmmm... If you want a truly honest answer, I wouldn't have left this for someone else to deal with and I can understand people being a little upset that you left it to your relief to do the paperwork on this. I know it happens, and that's just one of those things, but you clean up your own mess in my book.

lisa203 · Apr 26, 2012

So I appreciate your comments, and I to would normally do it myself and not leave it for the relief nurse, however there was still two hours to go in the case, and she insisted that I leave. She said their is too much time left in the case for me to write a report up and something else with the count could also go wrong. She had no problem with doing the report. It was the scrub nurse that seemed to be upset by the incorrect count. I understand that both of our names are going to be on the count sheet, and I do think that noting in the chart that the count was incorrect is something that must be done, but it was her attitude about it that aggravated me. Despite going through the garbage's, and doing multiple recounts, and agreeing to mark the count as incorrect she was still angry. I guess I was just venting about attitude.

CIRQL8 · Apr 26, 2012

Lisa, I must say that I think that you did the right thing. In this day and age of "fiscal responsibility," any overtime is discouraged and maybe even penalized. Even for a good reason, like staying over to "clean up your own mess." You exhausted every effort to discover the origination of the error and reported off appropriately. You accepted ownership of the error. It happens. If you've never written something down wrong, you haven't been in the OR long enough. The patient would get an X-Ray no matter what and an incident report would be filled out no matter what. And as far as your scrub being angry at the error (excuse my language) but tough sh*t. It happens. I am certain that s/he has lost a needle or sponge or two in their lifetime. Perhaps it was a bad day for your scrub and not because of you.

JenJen82084 · Apr 26, 2012

Perhaps your scrub was angry at herself for getting an incorrect count? It takes two to tango/count, so the fault cannot solely be placed on you. I disagree with the previous post about fiscal responsibility. To me, patient safety is far more important than money and I think any OR manager would agree. Spending the appropriate amount of time to perform the counting procedure including documentation actually saves the hospital money because it prevents retained items. The relief nurse had no right to tell you to leave your own case against your better judgment. Also, it is not good technique to reconcile a needle count with the wrappers from the garbage. Needles should be counted by two (one must be an RN) members of the surgical team as they are visualized by both people, and any discrepancy will result in an incorrect count/operative search/xray (if needle(s) cannot be located/accounted for.) Even if you wrote a number down wrong and can't figure out how it happened... we're human, it happens; write your report and be on your way.

CIRQL8 · Apr 27, 2012

I concur that reconciliation against wrappers is a bad idea. I did not mean to say the fiscal responsibility thing is a VALID reason to leave, just a reason management uses to enforce time usage. However, a bad count is a bad count. Once an item is lost, staying to finish the procedure serves no useful purpose. However, as the primary nurse involved at the time of the discrepancy, a report should have been filled out by that (the primary) nurse.

canesdukegirl, BSN, RN · Apr 28, 2012

I have added wrong before on my count sheet, and have been in exactly the same situation you describe. Now I write the needle count up on a whiteboard so that the scrub can see it too. I also record counts on the designated count sheet near my desk. It may seem like double the work, but it really helps when the scrub nurse can clearly see the needle counts and correct my math if I add wrong or if I add too many/too few needles. This way BOTH of you are in agreement.

Editorial Team / Admin · Apr 28, 2012

This is one of the reasons I save the wrappers to anything I add after the initial count. Added an 8 pack of pop-off ethibond? Wrapper goes on the desk by the computer. I also write under the added sutures what it was- if I add a 6-0 prolene, under the "2" I'll write "6-0 P" just so I know what it was and then I can correlate wrappers to my count sheet. When the initial count is 53 and we finish with over 300 needles, it's nice to know I have something to make sure the numbers match up!

RNOTODAY, BSN, RN · Jan 18, 2019

On 4/28/2012 at 1:02 PM, Rose_Queen said:
This is one of the reasons I save the wrappers to anything I add after the initial count. Added an 8 pack of pop-off ethibond? Wrapper goes on the desk by the computer. I also write under the added sutures what it was- if I add a 6-0 prolene, under the "2" I'll write "6-0 P" just so I know what it was and then I can correlate wrappers to my count sheet. When the initial count is 53 and we finish with over 300 needles, it's nice to know I have something to make sure the numbers match up!

That makes so much sense... but, in my last position, we were absolutely FORBIDDEN to match up the wrappers to make the count correct. It didn’t matter if you had Precisely the right wrappers to match your suture, if the count was wrong on the count sheet- it was wrong, period end of story, call X-ray and start your incident report !

cd1212 · Feb 2, 2019

I'm a new OR nurse and maintaining correct surgical counts has been difficult for me lately and I have been place on probation due to incorrect counts and I may be terminated. Even though I complete the initial surgical count with the ST and I believe that I'm keeping an accurate record of the surgical count others in the room will add items or throw things away which effects the counts. Often when this occurs I am not notified and when it's time to complete another surgical count it's incorrect. I would like to know others opinion on this issue?

Editorial Team / Admin · Feb 2, 2019

10 hours ago, cd1212 said:
I'm a new OR nurse and maintaining correct surgical counts has been difficult for me lately and I have been place on probation due to incorrect counts and I may be terminated. Even though I complete the initial surgical count with the ST and I believe that I'm keeping an accurate record of the surgical count others in the room will add items or throw things away which effects the counts. Often when this occurs I am not notified and when it's time to complete another surgical count it's incorrect. I would like to know others opinion on this issue?

Why are so many others in the room opening things? If you are the circulator, that is your room. If someone needs something, you should be opening it. If it is an urgent situation and someone else opens something, they need to inform you. Speak with your supervisor as it sounds this may be more of a systems issue with too many hands in the cookie jar.

cd1212 · Feb 2, 2019

To many hands in the cookie jar is precisely the problem and I feel like I'm in a no win situation. With so many people adding and taking supplies from the surgical count there will eventually be a miscount sooner or later. I've been so stressed at work lately and worried that I will lose my job over something I have no control over. I've been taking a more assertive position with the counts not trusting other nurses who have literally counted just minutes before me. I'm afraid to leave the room to take my breaks because of the risk of an incorrect count. The Resource Coordinators (RC's) and the OR manager are aware of the situations and nothing seems to be done about it. It doesn't help that some doctors will not allow the AORN recommended surgical counts to be completed during their cases which only escalates the problem.