Trauma Set Counts

[chazarama]

I work in a Level 1 Trauma Center Operating Room as a Scrub Nurse. I am an LPN and was wondering whether anyone can help.

Our Trauma Sets are pre-counted by 2 Nurses before they are sterilized as per our policy. This can be used as the initial count if the case comes up emergently and there is no time to count instruments. My concern is that it is counted and signed off, but not put together all the way and sealed until it goes downstairs to CSP. I feel this is dangerous because we have had a couple of times where our count sheet did not match out set after sterilization. We would like to close and lock the tray ourselves before it goes back to CSP after we have signed and counted it. That way nothing falls off the cart/table on the way down and the signers are accountable for the set if anything is wrong.

Does anyone have a policy as to Trauma Instrument sets?

Thanks,

Chaz LPN

[Rose_Queen, BSN, MSN, RN]

We don't have specific trauma sets, we just use regular laparotomy sets or whatever is needed. We never use the count sheet included in the tray, we always have the circulator and scrub count the set if possible. If not, we x-ray. Most of the time we are able to count before incision because one nurse will count with the scrub while another nurse is assisting anesthesia, position/prepping, etc. I think that in my 3 1/2 years doing trauma surgery, we've only not been able to count twice.

[chazarama]

I have been in the OR 15 years and I think I have only seen a couple of cases where counting was an issue at the start. During dayshift we have a ton of help of course, but nights and weekends can be the problems.

My main issue is I serve on the Unit Council and we are trying to fix some boo-boos of the past, and prevent anything bad from hopefully happening in the future.

We are lucky in the sense that when the count sheet has been wrong it's been caught ahead of time, but some staff feel that if the sheet is signed by either 2 RNs an RN and LPN or an RN and a ORT, that should be the first count, and I am from the old school where you always make sure yourself.

thanks again

Chaz

[Jarnaes]

Chaz, I'm with you, I'm old school too. :)

I have done my fair share of traumas and think the best policy is to count in the room, and if it wasn't done for whatever reason, then you do a X-ray to clear the pt, and of course, document, document, document. I wouldn't blindly trust the signed count-sheet in a set.

[Akpywackett]

Count if you can...x-ray if you must. That is all.