staff scrubbed in for a case are familiar with your policy, and some
surgeons rarely encounter incorrect counts. In the heat of the
moment, there can be a lot more questions than answers.
• When does the surgical team continue or pause closure? When do
they search for the missing item or order a foreign body X-ray?
• When does the scrub tech conduct a first closure count or repeat
count? When does she continue to search for the item?
• When does the circulator conduct a first closure count or repeat
count? When does she inform the attending surgeon or call the OR
desk/charge nurse? Does she place a foreign body
X-ray order?
That's a lot to remember and a lot to do. What every OR team could
use is a step-by-step, role-defined guide to help resolve incorrect
counts. We think we've come up with a pretty good solution — and it
hangs prominently on the wall in all 80 of the ORs here at the Ohio
State University Wexner Medical Center in Columbus, Ohio.
When a count is off, our OR teams simply look up at our "Incorrect
Count Algorithm," a 22 x 33 inch poster that condenses our 11-page
policy for resolving incorrect counts into a set of steps that you follow
in order. We used eye-catching colors to outline role-defined tasks.
We've found that an easy-to-follow infographic is the best way to
organize and structure complicated information.
Our retained object case
Necessity is the mother of invention, right? We created our poster in
response to a retained surgical item that happened on our watch in
2016. During a neuro case, we left behind a tiny sponge like the one
I'm holding in the photo on page 32.
The case, a Chiari malformation decompression, was unremarkable
until the first closing count was off — a 1 by ½ inch cottonoid was
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