6 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 8
groups of 10, but man-
ufacturing mistakes
can result in a pack
having too few or too
many sponges.) Note the initial count on a dry erase board using
a standardized 10-count format (for example: 10
10
20
10
30
10
).
• Separate. Hang sponge holders — each have 2 rows of 5
clear pockets to coincide with the 10-count format used to track
sponges— in the OR. During the procedure, retrieve used
sponges from the kick bucket and place them in one of the hold-
er's pockets. Load the holders from the bottom to the top to
make it easier for the surgical team to see if any of the last few
pockets are empty.
• Say. At the end of the procedure, the surgeon must perform a
methodical wound exam to make sure all sponges have been
removed. Nurses in the room should use the standardized 10-
unit counting system to make sure the "in" count matches the
"final" count before the surgeon closes the wound. A nurse could
say, for example, "show me 40 sponges." Another nurse then
confirms that the number of sponges in the holders match the
"in" count that's noted on the dry erase board.
"When the sponges are in the holder, they're not in the
patient," says Ms. Pelletreau. But, she adds, if a pocket is empty,
the missing sponge needs be accounted for before the patient
leaves the OR.
The system is simple to use — and it should be — because
adding unnecessary layers to the counting process only increas-
es the likelihood of mistakes occurring.
— Jared Bilski
On the Web:
Visit the NoThing Left Behind website for more
information about implementing the Sponge
Accounting System: nothingleftbehind.org
