Patient safety in a down economy?

linda2097 · Mar 9, 2009

Frankly, you shouldn't have found out which nurses performed an inaccurate count. That's none of your business. Staff and patient data is a need-to-know basis. The OR manager needs to know who made mistakes. You do not need to know.

Mourkoth · Mar 9, 2009

Hold on there Ms. Critical,

Lets cut the "I'm better than you finger pointing stuff". The chart was there in the room and I was the circulator. I just turned a few pages back and saw the old peri-op record. I'm not spreading gossip or anything. I believe in the "golden rule" routine. I wouldn't want everyone to blab if that had been my name on the first page. And as far as I know, the only other people that know the names are the nurse manager, and risk managment guy(or whoever the incident report eventually gets to).

I'm discussing this for a different reason. Patient safety. I think that due to severe staffing cuts, longer hours and compressed workloads, safety is being comprimised. I'm simply asking if this is all in my head (and my hospital is unique), or is this kind of thing is a trend and actually happing somewhere else?

Editorial Team / Admin · Mar 9, 2009

I find it hard to believe that in two years there has never been a wrong count- statistically there's an infinitesimal chance it happened. You should also look at what's going on when counting should be happening- is the person at the table trying to hold a retractor or follow a suture at the same time they're counting? Is the circulator dealing with phone calls and pagers? Counting is a human process, and like humans themselves prone to error. I believe the only way to ensure that nothing is truly left in the patient is to x-ray before leaving the room in addition to the counts.

We always count sponges and sharps twice- there have been times on the first count where there was a sponge in the incision that we knew about, but on the second count it was missing- and most of the time the doc would speak up and say, oh yeah, it's in the incision. We also separate the sponges fully- no flipping an edge and counting that way, it's possible to count the non-folded edge of a sponge as two.

I personally have been involved in wrong counts, some intentional (laps left as packing) and some where a sponge was put in to help hold the bowel out of the way and not removed before closing, which was discovered before the patient left the OR.

AORN also did an article in Feb 2008 about counting that I thought was really good. It can be accessed through www.aornjournal.org. Also, be sure your facility is following both AORN guidelines and the facility's protocol.

As to long shifts/ working short, most of our shifts are 8hrs. There are some who work 10, and very few who work 12. Most of time we have more than enough staff to cover all rooms, trauma, and still have some listed as PRN, who are still there the entire shift.

$fracturenurse$ · Mar 10, 2009

Wow, scary. I've seen it once, got called back for a lap left in the belly after a C-Section. I've witnessed many C-Sections and the L & D nurses just seem more lax then regular OR nurses. Having said that, I think wrong counts and retained laps, etc., can happen to anyone. Why it's happening so frequent to your facility, I don't know!

KayceeCA · Mar 10, 2009

We do a "retained laps" documentation when the laps were left in intentionally by the surgeon, in a trauma where he/she knows the retained laps will be removed at a later date. Are you sure that's not what you're seeing?

I have not noticed any break in professionalism at my facility. I find it hard to believe that OR staff would become lax with regard to counts and patient safety, regardless of the economy.

Karen