Initial/Closing/Final Count

shell07 · Apr 7, 2009

by Lap do you mean laproscopic? if so that is a clsd.procedure but I still count sponges(rays) and sutures for final but, not the instruments only in the begining in case of poss. open.

rn_jr · Apr 7, 2009

yes, laparoscopic, for closing I'll count only small things. But for final I was wondering what people usually count.

In addition for cases such as spines, or other cases where instruments may not be counted for closing and final counts. Do you count "all" small things for closing and again for Final count?

Editorial Team / Admin · Apr 7, 2009

We always count sponges and sharps plus any small items (vessel loops, bulldogs, hydrajaw inserts) for both closing and final. We always count instruments for laparoscopic case but never count them again unless we open.

rn_jr · Apr 7, 2009

thanks for responding, I personally will count "all" small things over for Closing and again for Final. However, I sometimes have a hard time with the scrub tech who questions me and usually gives me an attitude. I just feel better doing it, but then I was starting to question if perhaps I was doing too much....

Editorial Team / Admin · Apr 7, 2009

We sometimes get around counting all small things twice by having the tech drop them in the kick bucket as they count them the first time- then we know they aren't on the field and don't have to count them again.

Scrubby · Apr 8, 2009

We count everything inititally for lap cases, even abdo sponges in case of converting to an open case. And because we've counted them at the beginning we HAVE to include them in the final count as well.

MereSanity · Apr 13, 2009

It is the legal responsibility of the nurse to monitor the counts. If something is accidentally is left in a patient (or a scrub gets poked by a needle they did not keep track of) it is the nurses fault. You are the one that will be held legally responsible. The Dr. will say...well the nurse told me the counts were OK (who do you think they will fire)? CYB.

Heogog53 · Apr 17, 2009

I was taught a very long time ago that if there is ever a question about anything in the count, that anyone in the room could request a count at ANYTIME, period.

If you are the RN, and YOU feel the need to have everything counted on a small, medium or large case, then DO IT. IF the tech has an issue with it, and continues to have an issue with it, ask him/her why that is an issue for that person, try to settle it between yourselves first. If that doesn't settle it, then it's time to ask your superior to mediate between the two of you.

Bottom line, IT'S YOUR LICENSE on the line, not the tech's.

It can be tough to confront someone about counts, but legally, you have the right to check the count as many times as needed- and so does the tech. I've been in some huge messy cases where instruments and everything else was coming at me so fast that sometimes I'd want to count laps just to make sure that I knew how many I had- or the scrub would ask me the same thing. I remember one case we counted about 8 times, because BOTH of us were uncomfortable with our "soft goods/disposables" counts.

Good luck to you,

Helga