Revising Our Periop Countpolicy

[BAMJAM]

Our OR has a small group reviewing the count policy and trying to make appropriate updates and revisions. We are having conflicts of interest and varying opinions over instrument counts and the wording and actual procedure.

Controversial concerns are how to word policy for cases like Lapooscopic cases possible Open Laparotomy. Also cases like Incision and Drainage for groin or abdominal wounds. Also do others out there do official legal instrument counts for inguinal hernia repairs, fem-pop bypasses? We want to be legally correct but get rid of the sacred cows of days gone by. Help!!!Any resources appreciated...AORN guidelines are not specific enough for policies.

[Pedi-Gree, BSN, RN]

We count everything. We have preprinted lists for all possible types of surgeries with a line in front and at the end of each descriptor. The OR nurses put the actual count of each item on the left hand column before the case, leaving blank the ones not used. They both sign at the bottom of the left hand column. At the end of the case they put the actual count of everything on the right hand column. Then they both sign again at the bottom of the right hand column if the count is correct. If it's not they sign at the bottom of the page and list the steps taken to remedy the situation.

[justjenny]

Trying to remember specifics to try and help....

(1) the ST is always responsible for an "inventory count" upon starting and finishing a case - even when a full instrument count is not required.

(2) we always count "the small stuff" (sharps, sponges, small items)

(3) any scope possible open gets a full instrument count in the beginning and only a full instrument count if you actually open

(4) full instrument count required when will enter a cavity (peritoneum, uterus, etc.)

(5) mandatory xray at end of case for cases with multiple personnel changes and/or more than (5???) packs of sponges open (having a brain fart right now can't remember exact number) regardless of correct counts.

(6) all counts must be with two OR staff with at least ONE being an RN (except for inventory count previously mentioned)

HTH

Jenny

[mcmike55]

Over the past couple of years, we have re-introduced instrument counts back into our OR. We had dropped them for several years, but risk management/insurance people said we needed to start them again.

We've revised what we are doing several times since then, and I see more changes.

The problem I see was that instrument counts were easy "back in the old day", you just count!!

Today, with minimally invasive surgery, which at any time, could convert to an open procedure, often with different instruments, the job is much more difficult.

Currently, we count instruments any time we are entering, or potentially entering a cavity.

When we do, say a Laparoscopic Chole, we count sponges, etc along with the standard instrumentation, but not the long endoscopic instruments.

We began by counting everything, including the camera and light cord!

But over time, we were able to condense trays and eliminated things that we felt were virtually impossible to shove into an incision, at least in our hospital!

If the doc says that it's a good chance we will go from scope to open, we open only what we need, but often use a standard instrument tray, and not the laparoscopic instrument tray. We'll count this, and if we only scope, we're good, counting only sponges and needles, but if we have to open, we are ready.

We only x-ray in case of a miscount, or due to patient condition, we don't get time to do either a pre-op or post op count.

Mike