Lost suture/instrument...

[Gottago]

When a suture or instrument has been lost (cannot be accounted for after the final count), who is responsible, scrub or circulator (the focus of this question is solely based upon a lost item, not an incorrect count when someone forgot to add an item to the count sheet)? Assuming the circulator is the nurse in the OR, I've read and heard the argument that the circulator is to blame since the circulator/nurse is ultimately in charge of the OR room. I've always made the argument if a suture (vessel loop,etc.) or instrument is lost during the case, then the blame should be upon the person who physically controlled the item. Common sense: you touch it...you control it..., then it's your responsibility to maintain control of the item. I've never accepted the argument that the circulator is ultimately responsible for the item simply because the circulator is the nurse in the OR (this argument excludes CRNA's, of course since they do not account for surgical instruments, sutures, etc.). I often get the impression that scrubs believe lost items are not their responsibility, which I believe defies common sense. There have been times when a circulator drops sutures onto the sterile field; the sutures are properly counted by both scrub and circulator ("I dropped 8 sutures"..."Yes, there are 8 sutures dropped on the sterile field"; circulator then must leave the OR (for example to get another instrument); circulator returns to the OR to hear the scrub say, "I dropped a needle, and I can't find it"; then, circulator is faulted for not maintaining the OR. I have never agreed with this "logic" and never will. I realize this thread is subject to disagreement, but I think it is worthy of serious discussion. I will also add, I have heard scrubs say, "It's not my license that's on the line." This attitude, I believe, is counter to patient safety, which is the ultimate guiding factor. The intent of this thread is not to cause dissension, but to further discussion for a better OR.

[springchick1, ADN, RN]

These are my thoughts on this from a scrubs perspective:

I think it depends on the situation. If I've lost an instrument, dropped an instrument that has to be counted and didn't mention it, can't find a needle etc... then sure, it's my responsibility. But at the same time, it is YOUR responsibility as the nurse to call for an x-ray, notify the MD if he's left the room (just because I'm still scrubbed in and can't) and to do the documentation. You also need to help look for it. My hospital policy is you take an x-ray that has to be read by a radiologist, whether x-ray was used in the case or not.

If a needle is dropped and isn't seen on the floor, do you help look for it? Are you digging through the trash, looking on the bottom of shoes, looking at the base of the mayo cover is folded up just a teeny tiny bit (because we've found one there before)? Because part of that responsibility falls to you as well. Being sterile, there are a lot of things that I can't do that a circulator CAN do. And while you may not have lost it or dropped it, part of your responsibility is to help find it. (And when I say You, I mean circulators in general. I'm not singling you out specifically or saying that you aren't already doing these things).

As for the "It's not my license on the line", I have some thoughts about that. We as scrubs get told that ALL THE TIME by nurses. "It's not your license on the line if the patient is positioned correctly." "It isn't your license on the line if the patient falls off the HANA table because the boot slips." "It isn't your license on the line if the count isn't correct and something is retained in the patient." I think you get the drift. The things is, we have this beaten into us all the time. So when you hear scrubs say that it isn't their license on the line, it's because that has been beaten into us over and over and over again. It also makes us feel like we are inferior because we don't have a license.

[RobtheORNurse]

That is indeed flawed logic. Everyone in contact with that patient has a responsibility to provide the best care for that patient. The nurse is the patient advocate. The team is responsible, circulator, assistant, scrub and surgeon. It is a team effort and the procedure cannot be performed without the whole team therefore it is a shared responsibility. It sounds to me like you have a very unprofessional scrub tech and that should be addressed administratively.

[springchick1, ADN, RN]

It sounds to me like you have a very unprofessional scrub tech and that should be addressed administratively.

Aside from the scrub making a comment about the license (and I shared my thought about that earlier) what has the scrub done tht is very unprofessional? Because this whole post sounds like the circulator is trying to get out of being held responsible for anything.

[Rose_Queen, BSN, MSN, RN]

These are my thoughts on this from a scrubs perspective:

I think it depends on the situation. If I've lost an instrument, dropped an instrument that has to be counted and didn't mention it, can't find a needle etc... then sure, it's my responsibility. But at the same time, it is YOUR responsibility as the nurse to call for an x-ray, notify the MD if he's left the room (just because I'm still scrubbed in and can't) and to do the documentation. You also need to help look for it. My hospital policy is you take an x-ray that has to be read by a radiologist, whether x-ray was used in the case or not.

If a needle is dropped and isn't seen on the floor, do you help look for it? Are you digging through the trash, looking on the bottom of shoes, looking at the base of the mayo cover is folded up just a teeny tiny bit (because we've found one there before)? Because part of that responsibility falls to you as well. Being sterile, there are a lot of things that I can't do that a circulator CAN do. And while you may not have lost it or dropped it, part of your responsibility is to help find it. (And when I say You, I mean circulators in general. I'm not singling you out specifically or saying that you aren't already doing these things).

This. As a member of a surgical team, you are take part in responsibility for that patient's outcome. While you may not be able to directly control the instruments, sponges, or sharps on the field, you can certainly help search for an item and complete other actions as spelled out by your facility's count policy. Now, the expectation at mine is the person who had physical control of a missing item is responsible for completing the incident report; however, we work as a team to try to resolve a missing item, get the x-ray taken if necessary, and follow the policy.

[ORoxyO]

I guess I'm super lucky. Our techs and nurses work together to make sure everything is accounted for and to find those things missing. Our techs also help position and do other tasks as needed. They care about the patient, not the fact that they don't have a license!

Now when I worked in a larger urban OR...man....every man for him/herself!

[springchick1, ADN, RN]

I guess I'm super lucky. Our techs and nurses work together to make sure everything is accounted for and to find those things missing. Our techs also help position and do other tasks as needed. They care about the patient, not the fact that they don't have a license!

This is how my teammate and I are. We help each other. I remember things for her, she remembers things for me. I help position when I can and grab equipment while she grabs meds. She will get my next case ready for me while the room is being cleaned so I can get a quick break. We definitely have a team mentality. We are there to provide the best care and keep our patient as safe as possible. And the majority of the people I work with are like this. I don't care that I don't have a license (I'm actually in NS now). What I do care about are the few nurses that make scrubs feel like we aren't as good as they are or as important as they are because we don't have a license.