Lap vs Open Cholecystectomy

[KJAllen]

When a Lap vs Open Cholecystectomy is scheduled, does your staff set up for and count the open instruments in case it goes open suddenly?

[CourtneySentellRN, MSN]

Depends on how often the surgeon usually goes open. If you know they usually open then yes. Otherwise no, I would have everything in the room but not open and count till it's time but that's just me. I know my surgeons so I can pretty much guess which ones I would want to be prepared to open for before the case. 

Also depends on the facility (are there extra staff members to help)? Does your facility have enough equipment for the stuff to be opened if it's not used? Is there a policy that addresses this? Do you have a competent and experienced scrub that can handle the switch over quickly? Lots of factors to consider. 

[Rose_Queen, BSN, MSN, RN]

Always count the open stuff initially. If stays lap then we don't count instruments at closing. 99% sure that's AORN standard as well. Not counting is just a set up for something bad to happen. Now, disposables we don't open, and our standard set up lap or open has the instrument pans in use.