surgical count

Published

Currently working in an or where the techs refuse to count instruments. Stating we don't count instruments because it is not necessary..

Can anyone tell me, is this correct where you work? I am an old nurse who has always counted instruments before and after every case, along with laps, raytex, sharps, etc.

Up Vote Up Vote ×
Specializes in OR, Nursing Professional Development.

We only count instruments on cases where we open a cavity (chest, abdomen, etc). If it's a laparoscopic case, we count instruments before in case it turns into an open case but not after if it stays laparoscopic.

Up Vote Up Vote ×

We only count instruments for open cavities. The exception is kids under 25 pounds. We generally don't count on laparoscopic cases unless there's a high probability of opening.

Up Vote Up Vote ×
Specializes in Med/Surg, Float Pool, MICU, CTICU.
We only count instruments on cases where we open a cavity (chest, abdomen, etc). If it's a laparoscopic case, we count instruments before in case it turns into an open case but not after if it stays laparoscopic.

This or we do an post-op xray.

Up Vote Up Vote ×
Specializes in Operating room..

AORN guidelines state you count if you open a cavity (or potentially could...i.e. laparoscopic cases). There is no distinction for weight limits (peds should be counted)...however you ALWAYS count sponges and sharps (except maybe for a cataract)...however you don't just count because you could leave an item inside a patient....it is also for the protection of those on the field (missing a needle? Don't want to get stuck? How would you know? Not all scrubs are that conscientious) and protection for those cleaning up afterward.

MereSanity BSN, RN, CNOR

Up Vote Up Vote ×

I have always counted total instruments prior to a case. An open cavity, any area where the instruments can be placed inside the body, abdomen, chest, but also hip and shoulders. Too many lawsuits where something including instruments were found near a shoulder or hip. Also all laps the instruments are counted. I have never based any count on weight. So why is it this place does not count? I do not understand their rational at all.

Can you tell me, do you count prior to total hip or shoulders? And by count I mean a total not individual

Up Vote Up Vote ×
Specializes in Trauma Surgery, Nursing Management.

OP, are you working in the States? Can you give a little more info about not counting instruments, i.e., is this for every case, for particular cases; does EVERY tech refuse to count instruments, or just one?

Up Vote Up Vote ×

Every case. They will not count instruments. Stating they do not do that here. This is in the us

Up Vote Up Vote ×
Specializes in Operating room..

You are the nurse and IN CHARGE...that tech should be fired! Instrument counts have to do with how many "layers" you go through...hips, shoulders, knees...you do not count instruments but definitely everything else (sharps and sponges). Don't you have an AORN recommended standards book? That is the bible of the OR...and it sounds like you could be liable for not following it. If the tech refuses to count tell her she isn't scrubbing that case...and just because they have always done it that way doesn't make it right....remember YOU have a license to lose...NOT her!

Up Vote Up Vote ×
Specializes in OR, Nursing Professional Development.

Find your surgical count policy. Follow it. If the tech refuses, report him/her. Do not allow a surgery to start without the appropriate count; this may mean involving your charge nurse/nurse manager/powers that be. Also complete an incident report- in most facilities, these are electronic and go not only to the nurse manager of the unit involved but also to risk management. And if your facility does not have a surgical policy, the big question would be why not.

Up Vote Up Vote ×
+ Join the Discussion