Unit 3
-1) protects patient from possibility of postoperative complications in event that any item was
inadvertently left in patient
-2) to protect yourself and employer from legal liabilities
---surgeon, circulator, and ST each plan equal roles and responsibilities in counts and one or all
can be held liable for retained objects because of counting errors
---"captain of the ship" doctrine: surgeon assumes responsibility for the actions of assistants
employed by another entity---no longer applies---actions directed by facility policy, not surgeon
-3) to keep instrument sets complete (helps to cut down on instrument loss = cost decrease to
replace lost instruments - ANS-Purpose of counting sponges, instruments, needles, sharp items
-a serious and reportable event that should never happen to a patient
-leaving an object in a patient = UNINTENTIONAL TORT (includes negligence and malpractice)
-MALPRACTICE: negligent act
-NEGLIGENCE: a breach of duty omission or commission of an act that a reasonable and
prudent person wouldn't do in the same situation
-minimal, if any, legal defense possible in a case in which a foreign body is retained
-in this type of case, the jury will be encouraged to take into consideration:
-----did the team member act as any prudent, reasonable, professional would to account for
items prior to closure?
------testimony of expert witnesses
-----AORN recommended practices
-----facility count policies - ANS-leaving object in patient
-OR management team and personnel share in formulation of policy and procedures
-policy approved by nursing administrator over the OR, surgery committee, and director of
nursing services and hospital admin
-many hospitals follow recommended standards of practice established by AORN
-AORN continuously reviews policy and new guidelines are released each year
-AST established recommended standards of practice that are utilized in policy development
-count policy / procedures may vary between facilities, but COUNTS MUST BE PERFORMED
-count policy and procudure should be reviewed and / or revised annually (reviews incident
reports and near misses) - ANS-who establishes count policy and procedure
-good communication among team
-standardized processes
-counting
-wound exploration prior to closure
-use of technology (xray) as needed - ANS-strategies to prevent retained foreign objects in the
surgical wound
, -Sponges (any required for use during procedure)
-Sharps (knife blades, safety pins, hypodermic needles, cautery tips)
-cautery scratch pads generally counted separately
-Instruments (any instruments used and / or placed on sterile back table and mayo tray for
procedure
-Surgical needles (required and used for a procedure--may be atraumatic or eyed
needles)(usually counted separately, but may be counted with sharps,depending on facility
policy)
-may also need to count bulldogs, heparin needles, hip pins, syringes, suture boots, lig-a-clip
cartridges, defogger and sponge, depending on facility - ANS-Items to be included in counts
-during preop phase while sterile field prepared before procedure starts (ALL counted items
counted at this time)
---called initial count
---ideally should be performed before circulator gets patient and before mayo stand setup
-during intraoperative phase, if any additional counted items are added to sterile field not
originally present, and not included in initial count
-whenever there is a permanent change in scrub or circulating personnel (all counted items are
counted)
-before any part of a body cavity is closed (all counted items are counted except instruments)
-upon closure of peritoneum or joint capsule when surgeon makes the first stitch (all counted
items are counted)
---called 1st closing count
-upon closure of sub Q or skin (when surgeon makes first stitch (all counted items counted
except instruments)
---called 2nd closing count
-additional counts may be done whenever they are deemed necessary
***closing - ANS-when are counts to be performed?
-includes the beginning before the procedure, during the procedure, and at the completion of the
procedure
-perioperative = preoperative + intraoperative + postoperative - ANS-what is perioperative
phase of the surgical procedure
-SPONGE counts (3 taken)
---beginning, at closure of peritoneum, at closure of sub Q or skin
-INSTRUMENT counts (2 taken)
---beginning, at closure of peritoneum
-SHARPS counts (3 taken)
---beginning, at closure of peritoneum, at closure of sub Q layer or skin
-SURGICAL NEEDLES counts (3 taken)
---beginning, upon closure of peritoneum, at closure of sub q or skin - ANS-Counts during an
average procedure
-1) protects patient from possibility of postoperative complications in event that any item was
inadvertently left in patient
-2) to protect yourself and employer from legal liabilities
---surgeon, circulator, and ST each plan equal roles and responsibilities in counts and one or all
can be held liable for retained objects because of counting errors
---"captain of the ship" doctrine: surgeon assumes responsibility for the actions of assistants
employed by another entity---no longer applies---actions directed by facility policy, not surgeon
-3) to keep instrument sets complete (helps to cut down on instrument loss = cost decrease to
replace lost instruments - ANS-Purpose of counting sponges, instruments, needles, sharp items
-a serious and reportable event that should never happen to a patient
-leaving an object in a patient = UNINTENTIONAL TORT (includes negligence and malpractice)
-MALPRACTICE: negligent act
-NEGLIGENCE: a breach of duty omission or commission of an act that a reasonable and
prudent person wouldn't do in the same situation
-minimal, if any, legal defense possible in a case in which a foreign body is retained
-in this type of case, the jury will be encouraged to take into consideration:
-----did the team member act as any prudent, reasonable, professional would to account for
items prior to closure?
------testimony of expert witnesses
-----AORN recommended practices
-----facility count policies - ANS-leaving object in patient
-OR management team and personnel share in formulation of policy and procedures
-policy approved by nursing administrator over the OR, surgery committee, and director of
nursing services and hospital admin
-many hospitals follow recommended standards of practice established by AORN
-AORN continuously reviews policy and new guidelines are released each year
-AST established recommended standards of practice that are utilized in policy development
-count policy / procedures may vary between facilities, but COUNTS MUST BE PERFORMED
-count policy and procudure should be reviewed and / or revised annually (reviews incident
reports and near misses) - ANS-who establishes count policy and procedure
-good communication among team
-standardized processes
-counting
-wound exploration prior to closure
-use of technology (xray) as needed - ANS-strategies to prevent retained foreign objects in the
surgical wound
, -Sponges (any required for use during procedure)
-Sharps (knife blades, safety pins, hypodermic needles, cautery tips)
-cautery scratch pads generally counted separately
-Instruments (any instruments used and / or placed on sterile back table and mayo tray for
procedure
-Surgical needles (required and used for a procedure--may be atraumatic or eyed
needles)(usually counted separately, but may be counted with sharps,depending on facility
policy)
-may also need to count bulldogs, heparin needles, hip pins, syringes, suture boots, lig-a-clip
cartridges, defogger and sponge, depending on facility - ANS-Items to be included in counts
-during preop phase while sterile field prepared before procedure starts (ALL counted items
counted at this time)
---called initial count
---ideally should be performed before circulator gets patient and before mayo stand setup
-during intraoperative phase, if any additional counted items are added to sterile field not
originally present, and not included in initial count
-whenever there is a permanent change in scrub or circulating personnel (all counted items are
counted)
-before any part of a body cavity is closed (all counted items are counted except instruments)
-upon closure of peritoneum or joint capsule when surgeon makes the first stitch (all counted
items are counted)
---called 1st closing count
-upon closure of sub Q or skin (when surgeon makes first stitch (all counted items counted
except instruments)
---called 2nd closing count
-additional counts may be done whenever they are deemed necessary
***closing - ANS-when are counts to be performed?
-includes the beginning before the procedure, during the procedure, and at the completion of the
procedure
-perioperative = preoperative + intraoperative + postoperative - ANS-what is perioperative
phase of the surgical procedure
-SPONGE counts (3 taken)
---beginning, at closure of peritoneum, at closure of sub Q or skin
-INSTRUMENT counts (2 taken)
---beginning, at closure of peritoneum
-SHARPS counts (3 taken)
---beginning, at closure of peritoneum, at closure of sub Q layer or skin
-SURGICAL NEEDLES counts (3 taken)
---beginning, upon closure of peritoneum, at closure of sub q or skin - ANS-Counts during an
average procedure
