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!

[Future O.R. Nurse]

Just wondering, aren't we trained to count needles laps and anything countable before surgery, during and after?:confused: This is one of the biggest safety issues in the O.R. and counting is where a lot of the hands on training is concentrated. Pardon me, I am a CST and an R.N. student. Counting at the end and having the correct count determined if we passed or failed the exit exam. It should never be a question as we get into our field of work in a live O.R. with a live patient! God forbid this was a major trauma case with over 100 needles.:twocents:

[Rose_Queen, BSN, MSN, RN]

Just wondering, aren't we trained to count needles laps and anything countable before surgery, during and after?:confused: This is one of the biggest safety issues in the O.R. and counting is where a lot of the hands on training is concentrated. Pardon me, I am a CST and an R.N. student. Counting at the end and having the correct count determined if we passed or failed the exit exam. It should never be a question as we get into our field of work in a live O.R. with a live patient! God forbid this was a major trauma case with over 100 needles.:twocents:

In an ideal world, wrong counts would never happen. Unfortunately, real life is not the ideal world. A patient can go south so fast or a surgeon get into unexpected bleeding and you need to give them a suture NOW and he/she is using it before you can count. Odd things can happen- we once had a surgeon yank on a suture so hard (it wasn't a pop off, and he was trying to make it one) that the needle flew right out of the holder and across the room. We never found it, but because it was a wrong count, we had to do the x-ray even though everyone knew it wasn't in the patient. Sometimes holding up the start of the case isn't in the patient's best interest. The crashing ruptured AAA with no pressure, barely a pulse- I don't want to be the one telling the surgeon "Sorry, you can't start yet because we haven't counted." Don't see that going over too well. Not saying that not counting should be taken lightly, and used as an excuse on any emergency case, because most times you will still be able to count, but there are times it truly isn't possible.

[Future O.R. Nurse]

In an ideal world, wrong counts would never happen. Unfortunately, real life is not the ideal world. A patient can go south so fast or a surgeon get into unexpected bleeding and you need to give them a suture NOW and he/she is using it before you can count. Odd things can happen- we once had a surgeon yank on a suture so hard (it wasn't a pop off, and he was trying to make it one) that the needle flew right out of the holder and across the room. We never found it, but because it was a wrong count, we had to do the x-ray even though everyone knew it wasn't in the patient. Sometimes holding up the start of the case isn't in the patient's best interest. The crashing ruptured AAA with no pressure, barely a pulse- I don't want to be the one telling the surgeon "Sorry, you can't start yet because we haven't counted." Don't see that going over too well. Not saying that not counting should be taken lightly, and used as an excuse on any emergency case, because most times you will still be able to count, but there are times it truly isn't possible.

Yes, I totally agree with you! It is not ideal in every situation, nonetheless, it is a very important aspect to have practically mastered before you go into the O.R. and I stress practically. When I started out as a CST my biggest fear was all those safety issues that we witness in the O.R. such as the grounding the patient with the pad, the count, labeling meds, counting sharps and other countables, just making sure if you give one you get one back if possible. I know that is not always the case. I don't mean to seem like I'm above anyone, I am on this site to learn what I can. Counting was always such a major concern for me so much so that I never just left it up to the nurse to be correct. She had a lot of other things to think about also. So I did my best to help anyway I could.:) Thank GOD I never left a needle, a lap or an instrument in the patient.

[Future O.R. Nurse]

O.k. Forgive me, now I understand, she was new to the O.R. on orientation. Did she have a preceptor or did she do the TAH on her own? That is a big case when you are just starting out.

[divokevan]

I messed up big time today on a count. The thing was, when I was doing my first count, we counted open blades but there were two unopened blades on the field that I didn't put up (against my better judgement). Later, with the first count, we had two extra. I immediately knew the reason for this, but my preceptor was really mad. I was really mad at me. I feel like I should pretty much throw in the towel at this point. IDIOT IDIOT IDIOT!!! Now she will pretty much never trust that I did the counts correctly. On top of everything, I had to leave before the end of the case and eventhough we had a correct count, I'm sitting here wondering if everything went to hell right after I left.

I know its basic, basic, "you should have done this right" kindof stuff. But, I'm so new and I sometimes screw things up. GRRR. I wish I had known better. WHY LORD WHY????

[Scrubby]

I messed up big time today on a count. The thing was, when I was doing my first count, we counted open blades but there were two unopened blades on the field that I didn't put up (against my better judgement). Later, with the first count, we had two extra. I immediately knew the reason for this, but my preceptor was really mad. I was really mad at me. I feel like I should pretty much throw in the towel at this point. IDIOT IDIOT IDIOT!!! Now she will pretty much never trust that I did the counts correctly. On top of everything, I had to leave before the end of the case and eventhough we had a correct count, I'm sitting here wondering if everything went to hell right after I left.

I know its basic, basic, "you should have done this right" kindof stuff. But, I'm so new and I sometimes screw things up. GRRR. I wish I had known better. WHY LORD WHY????

Don't be too hard on yourself, we all make errors and as a new person in the OR it's part of the learning curve. Your precetor shouldn't react like that.... Unless of course they're perfect and have never messed up. Not many nurses out there can say that.

So in future the scrub nurse should either open the scalpel packets and have the blades counted or hand the unopened ones off the field. I wouldn't accept an unopened scalpel as part of a count. As a scout I don't accept any blades or sutures if the packet hasn't been opened because a countable item has to be seen by the scrub and scout nurse.