Instrument count question

[md979]

Hello, I have a counting question. I recently started working at a new facility in the OR. I was counting the other day for a laparoscopic bowel rsxn, possible open. The scrub tech had a major set & a lap chole set on his table. The lap chole set included a stringer of about 20 instruments plus forceps, retractors & knife handles. When we counted, he told me that they only count the major set and not the lap chole set. I said but if there are other instruments on your table & we are counting instruments, they should all be counted. He said that he won't use anything from the lap chole tray; the lap chole tray had the same instruments as the major tray just not as many of them. I said but if there is a discrepancy at the end of the case, we won't have a true baseline count if we aren't counting all of the instruments. I was still met with resistance after explaining why we should be counting all of the instruments on the table. Also, the procedure included about a 6 cm incision to bring up the colon & do the resection. Am I wrong for wanting to count all of the instruments? I'm just confused bc the other nurse in the room didn't really agree or disagree with me so now I'm second guessing my thought process.

[Rose_Queen, BSN, MSN, RN]

We count everything before incision. If we stay laparoscopic for a case with only trocar punctures, we don't count instruments at the end. For a lap bowel, we do because the incision is large enough to potentially lose something.

[md979]

My issue isn't with whether to count or not. My issue is the tech only wanted to count 60% of the instruments on his table. If you're counting, you should count all the instruments. Not just some of them. Right? I've only worked in one other OR & we counted all the instruments when counting instruments. We would never count only some of them. I'm just wondering if I'm crazy for thinking they should all be counted when counting instruments. í ¾í´”

[SQueenRN, BSN]

You were correct. The scrub was wrong. Everything on their back table is counted. Why was it on their table if they "won't use anything from the lap chole tray"?

[md979]

Exactly! If you need something from that tray, then just take the graspers & get rid of the rest. I was just shocked that the other nurse in the room didn't understand why I thought we should count everything.

[Argo]

If he didnt want to count it I would have made the scrub hand me that stringer, he can use the instruments from the major set. The place im at now has a set for lap bowel cases without a stringer, just 2 s retractors that are counted.

You were right that they should have been counted. The other nurses were impartial because they know your right but have gotten lazy and know they dont do the right thing.

[Rose_Queen, BSN, MSN, RN]

I would check what your policy states- I bet it's similar to the AORN guideline. And anything that has the potential to be left behind should be counted. If he didn't want to count it, it should have been handed off/not opened.

[imanurseintheor]

You count what you want to count. That's all there is to it.