1. Improved communication
Don't assume your staff is working together and communicating well.
Create a culture of communication. Try these strategies for improved
communication:
• Visible wall-mounted checklists on actions taken in the setting of
an incorrect count or when a device cannot be retrieved.
• Defined reports that move information up the chain of command.
• Report and discuss near-miss "counting" events.
• Use teach-back and hands-on learning demonstrations for compe-
tency assessments.
• Engage leadership in contextual inquiry and real-time audits.
2. Count and account
Don't just rely on your count. Counting, 1-2-3-4-5, is one part of the
practice for sure, but you should have a strong confidence that every-
thing is accounted for after surgery.
Specifically, it's not only what is counted in, and what is counted
out. It's that everything is accounted for — those items that were
counted in and put into the field — you must be physically present
and see that they are out of the patient.
Surgical sponges are physical objects, not theoretical concepts. If 10
sponges are counted into a case, 10 sponges must be physically pres-
ent out of the patient, all in one place, not 4 on the back table, another
in a kick bucket, 2 on the field, maybe 1 in the hand of the surgeon and
2 in the pockets of a counter bag. If you don't have them all visible in
one place, they can't be easily accounted for and errors or mistakes
can be difficult to recognize. If the mistakes aren't identified, then they
can't be corrected.
NoThing Left Behind, a national surgical patient safety project to
prevent retained surgical items, has developed a sponge management
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