count sheets

[joeshaf]

where are instrument count sheets put in your or's. On the outside or in the tray with the instruments.

joe

[ebear, BSN, RN]

????????????????????????????????????????????????

You don't count instruments???????????????????????????????????????

WHOA!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[Scrubby]

Where i work we have a count sheet that is inside the tray and has all the instruments as well as a count sheet on the operating room report.

You probably won't all like this ( I certainly don't) but the instrument count sheet is rarely filled out. This will sound like an excuse but for a large case often there simply isn't time to count every instrument on the trays. I will because i just tell the surgeon he or she needs to wait but most people i work with don't.

On the operating room report count sheet we count lap sponges, raytecks, neoloops, tapes, peanuts, patties, opthalamic strolls, artery clips, towel clips, scalpels, sutures, bulldogs, cologne clips, suture boots, half yards. We all do this part of the count because this is what goes in the patients medical records.

The instrument count sheet is not filed in the pt records, it goes back to the sterilising department.

[ebear, BSN, RN]

Scrubby,

Instruments can be left inside the abdominal cavity. What happens if the "sterilizing dept." is missing one? Do you just add one back in from the supply room? Not a good idea at all! Please have management review this practice. Counting instruments is standard procedure for any open abd. case in the U.S.

[Scrubby]

If there is a missing instrument from the tray we just add one.

I spoke with the CN in my theatre today about this and she told me there simply isn't enough room to include all the instruments used. When we sign the count sheet though we sign to say that we have counted everything. It's just that we don't tally all our scissors, clamps etc. Just what i mentioned in the above post. And we certainly don't count every single instrument out aloud with our scout either.

[core0]

If there is a missing instrument from the tray we just add one.

I spoke with the CN in my theatre today about this and she told me there simply isn't enough room to include all the instruments used. When we sign the count sheet though we sign to say that we have counted everything. It's just that we don't tally all our scissors, clamps etc. Just what i mentioned in the above post. And we certainly don't count every single instrument out aloud with our scout either.

That is the scariest thing that I have ever heard. We do huge cases and if we have to wait at the end for the RN and scrub to count we do so. Of course last week we had to take an Xray because we were missing an entire Thompson retractor (someone took it to another case and they forgot to count it out). We still took an X-ray to prove that it wasn't there. If you don't have time you make it. There is no excuse for this. Having done three bring backs as a tech (two for Ray-tecs and one for a clamp) I can't see how you can have this attitude.

David Carpenter, PA-C

[Scrubby]

[i can't see how you can have this attitude]

Ummm is this comment directed at me? If so, in my first post on this thread i stated that i didn't like the practice.

I'm interested in having a look at count sheets from other hospitals, to compare.

Just out of curiosity though, do you count every single instrument when your doing a huge orthopaedic case and is every instrument documented on the count sheet?

[core0]

[i can't see how you can have this attitude]

Ummm is this comment directed at me? If so, in my first post on this thread i stated that i didn't like the practice.

I'm interested in having a look at count sheets from other hospitals, to compare.

Just out of curiosity though, do you count every single instrument when your doing a huge orthopaedic case and is every instrument documented on the count sheet?

I understand that you don't like the practice. I will temper this with the fact that other countries do things differently. However, I cannot imagine any hospital in the US allowing this. AORN standards state very clearly that there need to be at least two counts of disposables and one count of all instruments for every case. I can say that as a CST I never omitted a count. I cannot see any OR nurse being willing to put their license on the line for this. I cannot see any physician be willing to put their license or livelihood on the line for this either.

There are plenty of cases of left instruments even with "correct" counts. The reason that these policies are in place is that there were even more left items before the policies and procedures were put into place. I notice that ACORN is the local equivalent to AORN. I would be curious as to what their recommendations are for this?

As for counts when I was a CST we counted every item on the field and noted every item that entered the field. Ortho cases are not even close to being the largest cases. Open heart and large neuro vascular cases can have more than 400 items to count. Where I work now in liver transplant we have three large pans plus the retractor. Easily three hundred items with disposables. All of them are counted every case. The counts are usually done before the patient gets into the room and then when closing. Since closing takes a while there is usually ample time to get counts done before we get to skin.

The only exception that I have seen is emergency cases such as AAA or trauma. In that case we would inform the physician that we had not counted and would get an X-ray after each case. If you are not counting instruments are you getting X-rays after each case?

I did not mean to attack you but from a US perspective not counting instruments is a very scary proposition. Part of it is the liability involved. Besides the insurance payout, a retained instrument can be a career ending problem.

David Carpenter, PA-C

[Scrubby]

[i understand that you don't like the practice. I will temper this with the fact that other countries do things differently. However, I cannot imagine any hospital in the US allowing this. AORN standards state very clearly that there need to be at least two counts of disposables and one count of all instruments for every case. I can say that as a CST I never omitted a count. I cannot see any OR nurse being willing to put their license on the line for this. I cannot see any physician be willing to put their license or livelihood on the line for this either. ]

I am comfortable with my practice because i do count every instrument, and so do other people. But i agree that it's wrong that two people don't count them all out aloud. It's definately something that needs to be brought up where i work.

And our surgeons are bad enough with being impatient and annoying when we do our count as it is, let alone being made to wait while each instrument is counted. A lot of them time they are so fast with their suturing that i haven't even finished my first count, when i'm starting the second count when the skin is already closed. Some of them just don't seem to get it. We actually have a surgeon who yells at theatre nurses when they count too loudly. I no longer work with this surgeon because of this reason.

[TracyB,RN, RN]

Wow... I can't imagine not counting, everything.

Our count sheet is also part of the patient record.. scissors, clamps, & everything else included.

We make time, whether or not the surgeon wants it. I guess it just depends on the room staff.. most of our docs are quite compliant and patient while we count. It's their license, as well...

[core0]

Wow... I can't imagine not counting, everything.

Our count sheet is also part of the patient record.. scissors, clamps, & everything else included.

We make time, whether or not the surgeon wants it. I guess it just depends on the room staff.. most of our docs are quite compliant and patient while we count. It's their license, as well...

Its the hospitals bottom line as well. If it comes out that the staff told the physician counts are complete and they weren't then the hospital is going to eat the entire amount. It may be a difference in living in a less litigious society.

In re-reading the OPs post it may be that I am mis-interpreting what is going on. What was mentioned was not having both parties count out the instruments. We used to do this also. When I was a tech when we were doing awake cases we would try to keep things quiet. For example the circulator would say 8 criles and I would count out the tip of eight criles. Then she would say I see eight criles and I would nod. It can be quieter. Not sure if it fits the letter of AORN guidelines but it fits the spirit. Now if you are talking about the circulator counting instruments without the scrub then thats another story and how instruments end up in places they aren't supposed to be.

David Carpenter, PA-C

[Mourkoth]

This debate is really not about patient safety. It is really instrument accountability, and cost containment. In a big OR, instruments sometimes get lost. Someone has to be accountable (or to blame). If it were simply a patient safety issue then we would do an x-ray at the end of each and every case.

I work at t 500 bed trauma center and we don't count any instruments.

[ebear, BSN, RN]

I disagree entirely. While it is true that there must be accountability as far as cost containment, the primary reason for the instrument count is because they can and DO get left in patients. Have you ever seen "When Surgical Instruments Get Left Behind" on the Discovery Channel? It is a real eye opener!! It is also an "open and close" legal case, as there is NO DEFENSE if this occurs. This is strictly against AORN standards. I am very surprised to see this post from a nurse in the U.S.!

ebear