instrument count records

We write any instruments added to the field on the current instrument count sheets so when we go to count it is right there with the others we have to count

:)

If you use an instrument tracking system as we do, you may have a data base of what is in your trays. Our trays have a packing list of its contents which is used for instrument count purposes as well as accountability for processing quality control.

I am working at a hospital that does not count instruments at all and don't get an x-ray(?)(travel assignment)

Does anybody else's hospital do this and what is the rationale for not counting instruments?

The not counting of instruments does not seem like a good idea. Even if it is a travel position you are still responsible for your patients safety and well being. There has to be a policy somewhere where you are working. If not let me know where you work so that my relatives may avoid that hospital. There is not a rationale unless the surgery does not involve working inside a cavity,ie burn surgery. That is really bizarre and would be very uncomfortable for me personally.

Yes, That is excatly my thinking.There is not even a place to record an instrument count on the OR record.There is a blank for sponges, and sharps-no instruments.I had never encountered this, and wondered if this is practice anywhere else, since sometimes when you are in one hospital awhile, the practices become commonplace and Right in your mind, when sometimes things change for some reason we may not be awre of-but, I could find no rational reason in my mind for not doing this.I will look at their policy-have asked many people about it-they all say they don't count instruments.

is there an instrument count sheet? the kind that comes with the sterile insturments. if so, the you as the circle can demand that your scrub count the instruments. just to make sure that the total on the sheet matches the actual number of instruments. we always count on open cavity cases. I even count on smaller cases just to be sure the count sheet is correct.

I knew one nurse that worked at a hospital that I was a travel nurse at, she said where they came from, they didn't count instruments (on open hearts!) but that the hospital insurance covered them. I never did understand that.

sorry if this is confusing.

I think instrument counts are the stupidest thing ever invented. What a freaking' waste of time and energy. I have NEVER seen a wrong instrument count. We never did them in the '70s and '80s, or even early '90s, and I used to do TONS of deep-belly trauma cases. For that matter, I only worked at one place that DID do them, in 1996, and that was only because their manager was so "by the book." (she, of course, was not an operating room nurse.)

I see people putting practically their entire back tables up on their mayo stands these days, and keeping them up there the entire case, so maybe they CAN'T keep track of what's up there.

When I trained, in Navy OR tech school, we were taught to be minimalists--put up on your mayo only what you are going to be using AT THAT TIME; when you are done with it, put it in your rinse pan. Bring things up in stages, as you use them, then put them back,and you will never lose track of where your instruments are.

We were taught: Put no more than a PAIR of any item on your mayo. I often put up only a knife and a couple of clamps to start a case, then add pick-ups and Metz as they get to that point--you get the picture.

Instrument counts are just plain stupid. When people stop putting instruments up on their mayos in random order -- 13 tonsils, 17 long Allis clamps, 2 or 3 each of short, medium, long and extra long debakeys, an entire STRINGER of vascular clamps ("just in case we hit a bleeder") every right angle known to man (I am not kidding you; this seems to be a common practice) THEN maybe we will be allowed to be treated as individuals with common sense, and be trusted to know what's up on our mayo stands, and get the he** away from instrument counts.

I was taught to count instruments, sponges and needles and still adhere to that rule. I have , however become not as concerned as I once was. Instruments are not on my top priority list, but sponges and needles are. I think you have to look at what type surgery you are doing and make a decision then what to count and what to forget. An a-v fistula is not going to get much more than a needle count, because instruments and sponges are going to leave quite a large lump! I have been involved in a few cases where we removed sponges left in patients from surgeries done years before, so I do tend to want to count these on belly cases. I think hospitals that don't adhere to AORN Standards for counts tend to put them into a liability situation. The other hospital I work at part time did not emphasize counting when I first stated there but now with new people they do counts correctly using count sheets and boards to write them out. For your own protection it would be wise to follow AORN Standards because that is what the lawyer for the other side will ask you. Mike

We do not do instrument counts at the very busy OR where I work. Several years ago they talked about it, but it never really got anywhere. In the six years I have worked there I have never seen a patient come back for a retained instrument.

We did have one come back for a retained blue OR towel. They found in 6 months post op on a routine CT scan. Thought it was a tumor in her bowel. Poor lady.

Mike, none of us are questioning sponge and needle counts. Well, of course, there will always be people who want to do sponge counts on cases where they truly are not indicated, like finger lacerations, minimal incision surgeries like lap choles, and on eye cases--even on I&Ds of infected wounds, where no suturing is done, and the wound is packed open--EVEN ON CADAVER ORGAN HARVESTING CASES, for God's sake-- on that last, don't get me started. That subject, alone, could be the issue of another thread.

They, again, are just being very "by the book" and not using the common sense God gave them. We are allowed to write "Count Not Indicated--Minimal Incision" or the like on cases like those, but some RNs (again, usually the ones who don't scrub) want a full count on EVERY CASE, no matter how minimal the incision, or whether the patient is dead, as I just described--including instruments.

I, too, have seen the blue towel left in the belly. Most ORs write "Blue towel x 1 in Pelvis" or something similar so that the team does not forget to remove and account for it when they close.

I think a good rule of thumb is, and I was taught this, is, if anyone in the room requests a count, at any time, of any item, JUST DO IT, without argument (even if, like me, you might sometimes be wondering the rationale for the count.) You can always discuss it later, and may even be able to open up a group discussion that might effect some changes in some old "sacred cow" policies and procedures, or at least in peoples' perceptions of why they do things.

stevierae,

I agree with what you said. Too many anal retentive people. Common sense sometimes is never in the picture. Mike

Hey Mike--

Where is West Point, CA? Do you guys need any travelers there?