After a big open case my new hospital only counts the instruments only once at the end-when they start to close the fascia (1st count). I think this is unsafe because a instrument (mosquito, probe,malleable, kelly, etc.) can get lost after a first count and somehow end up in the body. If you only count the instrument once at the end, you still have another layer to close so how can you truly say that you are 100% certain that no instrument is in that body?
[[My old practice was that once you start to close, you count all instruments but keep a separate tally of how many instruments are still in use. Then, after the fascia is closed and you are on skin (the final/last/resolution count) you ensure all the instruments on that separate tally are still present. I have also heard other hospitals, doing an instrument count all over again. ]]
So I am tallying up other places, how many times do you count instruments at the end of a open case? And, is that really enough?