NoThing left behind

I work at an HCA facility in FL and all L & D nurses are required to complete CNE on retained surgical items which includes the "Nothing Left Behind" practice recommendations. In my unit, once a patient is in active labor a sterile instrument table is set-up using a standardized lady partsl delivery pack that always contains the same 12 instruments, 4 small and 1 large radiographic lap pads, as well as other misc (non-counted) items such as bulb syringes, sterile drape, gown, etc. We do an initial count prior to delivery and a final count after delivery (prior to the OB leaving the room). Because the tables are standardized any additional sponges, instruments, sutures, syringes, etc are added as needed and recorded on the count sheet. We have the same blue sponge holders that we use in the OR in all the delivery rooms; however, we typically don't use them unless additional laps are added to the table (although we probably should be using them).

We use Centricity Perinatal (CPN) EHR software at my facility and there is a specific area in the delivery record to document lady partsl Delivery Counts (who did the counts, the date and time they were completed, and what items were counted). Prior to leaving the room the OB/CNM counts the laps, the instruments, the sutures or other items (if added). If the count is off no one leaves the room, the immediate area is searched, all trash cans, kick buckets, drapes, etc are searched. If item remains unaccounted the OB visually and/or manually searches the lady partsl cavity and if still not found a STAT X-ray would then be ordered.

Yep, what Labornursepgh said. We have standardized kits with a set number of items, and do a count before/during (if laps or needles/instruments added)/after. Laps unaccounted for require a search or an xray until that lap is found, and all counts are documented in the EHR as well as who did the counting and who verified.