Sharp/Instrument Count Question

[BeanRN]

I am a RN new to the OR and currently on orientation. The other day, I circulated on a total abdominal hysterectomy. This procedure required lots of suture, we used almost 50. The thing was when it came time to count, we counted two extra needles on the field than I had on my count sheet. It seemed like I forgot to write down two sutures I passed to the field. My questions are:

- Does the pt. need an x-ray if the count is incorrect in terms of counting extra sharps,instruments on field than what was written on sheet?

- Also, any tips to help remember to write down any countable items passed to field? It can be easy to forget when so many other things are going on.

Thanks!

[Rose_Queen, BSN, MSN, RN]

Our policy is wrong count=xray. Doesn't matter if too few or too many. If you've already got extra, what's to say that there aren't even MORE extra?

I've found that if I add a lot of sutures during a case, saving the wrappers to what I've opened helps serve as a reminder to write them down- they go right under the clip on the clip board, so there's no excuse not to write it down. I've also started writing what type of suture- that way, I know that if I write 1 needle, but the type is prolene (always double armed) that something's wrong, and hopefully catch it right there.

With time, you'll get to know "standard" counts- i.e., on a laparotomy you always have x number of retractors, x number of kellys, etc.

[NurseLumpia]

What about placing your count sheet where you will likely open your countables, as soon as you open you are documenting. :)

[Mr. & Mrs. RN]

Always write down immediately after opening...no matter what is going on...and I save my wrappers also

[Rose_Queen, BSN, MSN, RN]

We do have a few exceptions: needle 6-0 or smaller (won't show up on xray), intentional retained items (laps left for packing/hemostasis), or patient is so unstable that extra time in the OR would be detrimental (ie, extremely unstable trauma patient). For cases where we didn't have time to count at all (ruptured AAA, trauma, etc.) we will count sponges at the end just to see if we have that multiple of 5 or 10, but always xray unless patient is too unstable or expired.

[nmred]

I keep my wrappers as well. The scrub should be keeping all sleeves and sterile wrappers. I NEVER toss/remove the trash from the room until the case is completed. Just in case you have to go digging for items.

[BridgetJones]

We have dry-erase boards in the rooms for counts. Like someone else said, I write whatever I passed off on the board, immediatly. Just make it a habit. There aren't too many things that are pressing enough that you can't take 10 seconds to add something to your counts. :)

[hodgtd]

I routinely circulate for Whipples. The needle count is usually over one hundred. My process: I write the number of needles added at any one time (and total number) on a white board, save the wrappers by folding them over the stack of wrappers I have previously given and write the total number on the top wrapper in the stack. The stack of wrappers acts as a check to the white board numbers. It seems like a lot of extra work but the redundancy of the system has saved me from many seemingly incorrect counts (ex. addition errors). It also provides a record of what was given and how many at any one time (cross referenced between the stack and the white board). This can be checked against the packages that the scrub also saves. When I'm busy I say out loud the number of needles added and the total, throw the wrappers I've just given on my workstation, and because they are not neatly wrapped around the stack it's a reminder to write the total on the white board and the charge sheet when things settle down.

[SandraCVRN]

We do have a few exceptions: needle 6-0 or smaller (won't show up on xray),

We still take an x-ray, even tho we know a 6-0 or 7-0 won't show up. We have to have a radiologist read the film unless its the middle of the night and there are none in house.

I write whatever I passed off on the board, immediatly. Just make it a habit. There aren't too many things that are pressing enough that you can't take 10 seconds to add something to your counts

Sometimes easier said than done, when something is hitting the fan in a CV case, 10 seconds is a long time.....

[BridgetJones]

We do have a few exceptions: needle 6-0 or smaller (won't show up on xray),

We still take an x-ray, even tho we know a 6-0 or 7-0 won't show up. We have to have a radiologist read the film unless its the middle of the night and there are none in house.

I write whatever I passed off on the board, immediatly. Just make it a habit. There aren't too many things that are pressing enough that you can't take 10 seconds to add something to your counts

Sometimes easier said than done, when something is hitting the fan in a CV case, 10 seconds is a long time.....

You're right...that's why I included the "too many" part...there are always exceptions. :) Maybe the best thing to do in that situation would be to keep the suture packets in your pocket or put them in an empty specimen container by your workstation until you can add them to your counts. Or maybe just have a really good memory, but I find that I start second-guessing myself 5 minutes later if I have to ask, "Did I write that down or didn't I? Was that 6 or 8? Darn, I know it was a multiple of 2..." I try to save myself the stress and just write it down as soon as possible.

[Tiffany, RN, BSN]

For us, incorrect count=x ray. I once had to do an x-ray for an extra forcep that we found at the end of the case (set had too many and we overlooked it during the initial count.) Its always a good idea to go ahead and do the x-ray so that your bases are covered *just in case*. I like to keep my wrappers and write down what kind of needle in case something fishy happens at the end. Also another thing, if I signed the initial count, unless I have relief, NOBODY writes on my count sheet but me. That way if something is missing, there is no he-say/she-say involved.

[Scrubby]

If I'm scouting for a large case and I've been relieved I always get the scrub nurse to count their suture packets which we always keep on the field.