When do you count ?

What your describing does sound like a concern to me. Don't you have an anaesthetic nurse? Are you expected to do both roles? Sounds unfair and i would be looking for work elsewhere. Where i work if it is a big case with lots to count the instrument nurse will scrub in early and set up. If it's a small case with less instruments we have more time. We usually have two scouts plus an anaesthetic nurse so one scout will help with the patient, the other scout will open up extras and count. That way by the time the patient is ready, surgeons have scrubbed in etc the count has been done and we're ready to start.

I count before my case if I know that Anesthesia is not going to have to put lines in. Most of the time I have time to count once in the room with my patients in big cases, because Anesthesia does an Art line and IJ which takes 10-15 minutes. It is ideal to count prior to bringing the patient back, but the way everyone pushes you to be in the room, it is hard.

We too count before the pt is brought to the room.

We'll try to get a head start by having the tech scrub before the case is totally open. That way he (she) can sort stuff out as it's opened, and better organized a little sooner, and then we can count.

Often after I drop off a pt in PACU, I'll stop by our pre-op holding area, and talk with the pt, and do a quick check of the chart.

Then I'll go back to the room, with updated info, set up, and count.

By then anes. is done with the pt.

I'll review anything that needs done, then move the pt to the room.

Our biggest problem counting is a scope possible open. We'll often condense a couple of trays, throwing off redundant instruments. It works ok, but sometimes it's a real hassle.

Mike

What your describing does sound like a concern to me. Don't you have an anaesthetic nurse? Are you expected to do both roles? Sounds unfair and i would be looking for work elsewhere.

Yes, I'm expected to do everything. I get the patient onto the table, help anesthesia hook up the patient, intubate, etc. The scrub techs like it this way and will absolutely not scrub in and count prior to the case because they don't want to sit in the room and guard the sterile field while the RN goes to get the patient. They hang around and watch for the RN to come with the patient and then come into the room. I put my foot down today and refused to go and get the patient until my scrub came into the room and I counted my case. Now the games will begin because during the closing count a raytec came up missing... it was under her foot after she made me look all over the place for it.

If your the RN then your in charge of the techs aren't you? If i had to do the anaesthetic nurses job, scouts job and have to supervise an unlicensed HCF then they would just have to fit in with what i'd be doing.

If your the RN then your in charge of the techs aren't you?

I wish it worked that way here. If I play the "I'm in charge" role, it would be a disaster for me. It's like Planet of the Apes and the techs run the world at this hospital.

Is there any hospital in the US that doesn't have OR techs?

I wish it worked that way here. If I play the "I'm in charge" role, it would be a disaster for me. It's like Planet of the Apes and the techs run the world at this hospital.

Dude, you're preachin' to the choir. I feel you, my man. It's a tech world where I live, and like you, I'm expected to do the same multi-task stuff. Sometimes I feel like the tail is wagging the dog. But, for the most part, most of the techs are good folks, who work as a team. But, there's always an odd-ball who has their moments in the sun.

Good luck with your team. The "When do you count?" question often seems to be done on the fly where I work. Nothing like having a shoe-string-and-a-prayer.

Regardless of who is in charge, it should be reported at least verbally to the charge or manager. It is a clear danger when games are played concerning counts or anything else that can interfere with patient care.

In my facility, the count is most often performed after the patient is brought back because the nurse does not help to open. Many times I am still opening supplies while the patient is being carted into the room. We do however give assistants to the surgeons if they do not have their own or their own are doing something else. They “second circulate” until it is time for them to scrub. Fortunately everyone knows their job and how to make it run smoothly for the benefit of the patient instead of playing dangerous games.

I feel for you, OR male nurse. I have been fortunate. I have not experienced being around places where the good of the patient isn’t weighed first.

In my facility, the count is most often performed after the patient is brought back because the nurse does not help to open. Many times I am still opening supplies while the patient is being carted into the room.

So... when you do an open laparotomy, you count all the trays and the bookwalter after the patient is in the room because you have a second RN or CRNFA that will get the patient asleep while the circulating RN counts with you (provided you even have your stuff open) I can't imagine still trying to open trays and packages while the RN is wheeling the patient into the OR. That sounds even worse than my position.

so... when you do an open laparotomy, you count all the trays and the bookwalter after the patient is in the room because you have a second rn or crnfa that will get the patient asleep while the circulating rn counts with you (provided you even have your stuff open) i can't imagine still trying to open trays and packages while the rn is wheeling the patient into the or. that sounds even worse than my position.

correct but the “second circulator” may be a cst or cst, cfa as well as rn or crnfa. the main circulator (always rn) attends the patient and assists anesthesia while the second circulator gets counts and “feeds” the scrub whatever they may need. getting set and the counts really isn’t as bad as you may think. when everyone functions as a team, it goes smoothly and is for the benefit of the patient. we have some people who don’t like others but one would never know it watching a case because they never allow it to affect their jobs. i hope your problem with the staff gets worked out.

correct but the "second circulator" may be a cst or cst, cfa as well as rn or crnfa. the main circulator (always rn) attends the patient and assists anesthesia while the second circulator gets counts and "feeds" the scrub whatever they may need. i hope your problem with the staff gets worked out.

thanks for the comments. it's not really a problem with the staff i'm hoping. this one time i did insist on counting first and she played a little hide the raytec game. i'm thinking it was an attention getter as to who rules the roost. our count policy states that the circulating rn must be the one to do the count. therefore someone else coming into the room can't do the instrument count for you. i have had the coodinator come into the room to help (once or twice) to do the count on the fly method. she helps anesthesia with the patient, while i counted and ran to get stuff that was forgotten. it was still busy and frustrating to be making noise while trying to put the patient to sleep.

thanks again