Keeping The Operating Patient Safe By Accounting For All Items Used During Surgery
Below is a MRR and PLR article in category Health Fitness -> subcategory Other.
Ensuring Patient Safety: The Importance of Accounting for Surgical Items
Summary
Before surgery begins, a meticulous process called an instrument count is performed to ensure patient safety. This involves counting each piece of sterile equipment, a task carried out by a registered nurse and a scrub nurse or technician.Article
Many surgical patients are unaware of the critical process that occurs before their procedure: the instrument count. This meticulous task ensures that every piece of sterile equipment used during surgery is accounted for. This responsibility is shared by a registered nurse and a sterile or scrub nurse. In some areas, this role might be filled by a scrub technician.
As each tray of instruments is introduced to the sterile field, both nurses carefully verify its contents against a detailed inventory sheet, ensuring every item is counted precisely.
All sterile supplies, including sponges, sutures, and needles, are meticulously counted. Sponges, typically in bundles of five or ten, vary from large gauze bundles to small peanut-shaped pieces. Even cotton-stuffed gauze pillows and different types of sutures?"and separate free needles?"are accounted for meticulously. These items pose a risk of being inadvertently left inside a body cavity.
There’s ongoing debate about which types of surgeries are at higher risk for leaving objects behind. Generally, in most states, instrument counts are mandatory for surgeries that open body cavities, like the head, abdomen, or chest. Similarly, in some gynecological surgeries, sponges and needles are also counted due to similar risks.
Minimally invasive procedures, such as laparoscopic gastric bypass or laparoscopic-assisted vaginal hysterectomy, involve small puncture wounds with instruments accessing cavities through specialized sheaths. Although these surgeries might seem less likely to retain foreign objects, small parts like screws or segments of surgical tools have occasionally been left inside patients, necessitating further surgeries.
Ultimately, while the surgeon is responsible for ensuring all extracted instruments are complete, the surgical team?"including nurses?"plays a vital role. Nurses must understand an instrument’s construction to report any missing parts promptly.
For instance, during a back surgery, I noticed a bone instrument was missing a screw. Although it didn’t affect its function, it necessitated an intraoperative X-ray to confirm the screw wasn’t left inside the patient. Fortunately, it wasn’t.
For further details on these protocols and more, refer to the resources below.
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