I am new to the OR, and while I know that an incorrect count is not a good thing... but just how bad *is* it...? Are you subject to disciplinary action for it? Like, I dunno.... can someone explain??
For instance, my facility has had I think 5 incorrect sponge counts in the last 2 months.... the missing sponges were never found, x rays taken in all cases.The educator is po'd. Where do these sponges GO???!!!! I dont understand.
I found out the other day that a case I had started had an incorrect sponge count, when I *know* the initial count was correct. (I was relieved for the day, the nurse told me the next day). Am I going to be disciplined for this? I really dont know where this falls..... when the count is wrong, but not left in the patient.....
Can anyone shed light on this for me? Now I am scared, wondering if I can handle this OR gig....
(besides the basics, I know why we do counts, when, etc just want to make that clear)
3. Also I have heard tech's say if they don't like the nurse then things will come up missing.
If such statements are made, it should be reported. Tech or not, everyone in the OR is a patient advocate, speaking for the patient when the patient can not speak for themselves. I do not think the patients would appreciate such a suggestion.
If the report of what is said by the "tech" is not taken seriously by administration, tell them it will be listed in the next incident report filed when there is a wrong count with that person in the room.
If you do not want to go as far as reporting the "tech", you may want to inform them when the statement is said that a wrong count is filed in an incident report with the names of both the RN and tech. It takes two to make a wrong count so if bad practice is determined, they are just as responsible.
If such statements are made, it should be reported. Tech or not, everyone in the OR is a patient advocate, speaking for the patient when the patient can not speak for themselves. I do not think the patients would appreciate such a suggestion.
If the report of what is said by the "tech" is not taken seriously by administration, tell them it will be listed in the next incident report filed when there is a wrong count with that person in the room.
If you do not want to go as far as reporting the "tech", you may want to inform them when the statement is said that a wrong count is filed in an incident report with the names of both the RN and tech. It takes two to make a wrong count so if bad practice is determined, they are just as responsible.
OK I'm finished now.
Yes, excellent point. However, not all techs are as dilligent as some. Where I work, most simply have the attitude "Hey, you have the license to lose (the nurse), not me"... :uhoh21:
My biggest place to find lost laps is in the bottom of the trash. Having doc's look at me like I'm on drugs turning over trash cans to find them.
1. seen docs wipe prep site then throw the lap across the room into the trash.
2. doing two procedures when breaking down the draps things fall and people like to pitch things in the trash.
3. Also I have heard tech's say if they don't like the nurse then things will come up missing.
Yup, I have heard the last one, too. Makes me crazy.. this is not a game, for crying out loud. Also, if they dont like the nurse, they will have you running all day out of the room. Sad.
A patient never has a retained sponge/instrument if the count is wrong.
Why? When the count is wrong, you tear the joint up looking for the thing. You don't find it, you get an X-Ray. X-Ray is negative, chances are pretty good that there is nothing in there. Most things show up pretty well, depending on size and angle (like smaller needles).
Count is correct - no corrective action is taken. If there is an error in the count resulting in a CORRECT count, patient will probably come back for an Ex Lap or something due to sepsis or ascites (of course, this is all site specific!).
Excessive wrong counts with the same team should be looked at, yes - but for the department as a whole? Deoends why. Does the department have a 'slacker' outlook about counts, or do you all see it as the important part of patient safety that it is?
I've heard of places that work on an 'exchange basis' only. Don't count, and don't do routine X-Rays. Also heard of places that only count smalls and do routine X-Rays.
Worried about excess gamma radiation exposure to the patient? Why? It is a cumulative effect, and you get more radiation walking to your car that you do with a couple of X-Rays. I'd be worried about the staff that are excessively exposed. Distance is your friend when it comes to X-Rays. That and lead!
Worried about excess gamma radiation exposure to the patient? Why? It is a cumulative effect, and you get more radiation walking to your car that you do with a couple of X-Rays. I'd be worried about the staff that are excessively exposed. Distance is your friend when it comes to X-Rays. That and lead!
But what about the patient that had osteomyelitis that has undergone extensive x-ray procedures including bone scan just to have another film shot?
As a patient advocate, it is our duty to ensure that minimal exposure, minimal invasiveness, is performed for their safety. That is why docs do not take appendix as a routine anymore unless there is a real need.
I do agree with what one of our docs say that goes hand in hand with what you said; "The only true wrong count was a correct count".
Another thing about "cumulative effect, and you get more radiation walking to your car that you do with a couple of X-Rays" ....If that is true, then an infant could be exposed to 18 or 20 cranial shots without incident, it would be like being at the beach for a day. I don't think so. It really doesn't add up!
I'd rather get an X-Ray that not if the count is wrong - I'd rather have a correct count than not. X-ray exposure is the least of the problems if the count truley is incorrect. I'm not advocating willy-nilly X-Rays for every body, just trying to make a point that you have to have priorities, and not worry aboy X-Ray with an incorrect count. I always look for the lost item before calling for X-Ray. I want a correct count for a patient w/ osteo as much as I do for a 'healthy' patient (and vice-versa). Also, I hate the paperwork for an incorrect count!!
It's not the 'incorrect' counts that cause a problem, rarely do they go unresolved. It's the uninvestigated 'correct' counts that slip through the cracks and come back to haunt us FOREVER! The sponges never found are the ones no one had to search for...until it's too late.
As a former OR nurse with nearly 40 years in the OR who lost her job and career and pension and any chance to rehire at age 59 over a raytec used as a post-D&C tamponade, admittedly placed by the doc after all counts were recorded, I can attest to the fact that IF policy dictates that the nurse signing the OR record is accountable for all entries they are, indeed, responsible for EVERYTHING.
Check your job description. If you wish to take the credit for running your room, you'll need to accept all blame as well. The more money you make, the more 'responsible' you become. Sadly, the underpaid and overworked, unappreciated scrub techs are more aware of how the game is played than their stressed-out circulators.
Too, if your employer and/or union has an established 'progressive discipline' clause along with a zeal for ALL incident reports to generate disciplinary action...doesn't take long to weed out the undesirables.
But even one unresolved count is unacceptable, five is outrageous!! HAS to be intentional methinks.
Don't worry; just be diligent about keeping track of the count. Everyone who works in surgery needs to be a little OC to keep tabs on things like the count. You're new and it will take a little time. I would keep a close eye on the people who were at the field on the wrong counts, especially anyone who would make a threat like the missing sponge.
Now I am scared, wondering if I can handle this OR gig....
Marie_LPN, RN, LPN, RN
12,126 Posts
Good grief.