system, as detailed on its website (nothingleftbedhind.org), to make
it easier for you to recognize when and if an error in counting has
been made (see "8 Ways to Spot an Error in the Count" on p. 56).
An important element of this practice is that the physical object, the
sponge in this case, must be found. If you don't find it, then you must
take actions to prove that sponge is not in the patient. You can't assume
that it's not in the patient just because it hasn't been found or you didn't
see it on an X-ray.
3. Establish a wound exam practice
Your OR team should perform a methodical wound exam before the
wound is closed. It's on your staff to remind the surgeon to do the
exam before nurses start to do a closing count.
The surgeon needs to carefully inspect the wound to remove any
surgical items that should not be left inside the patient. The exam is
done first to make sure everything is out. If something is missing, the
surgeon should repeat the exam. Doctors often wait until they are told
that something is missing to do the wound exam. This is a backwards
approach. They have to do the wound exam first, and it should be
done in every case.
If you have an incorrect count after the exam, the surgeons should:
• Stop closing the wound and remove fascial sutures and place
retractors.
• Repeat a methodical wound exam.
• Actively look and feel for the missing item.
• Consider getting another set of hands to feel around for the item.
• Cover the wound with a towel or plastic drape.
• Call for X-rays and get two views, an AP and an oblique or lateral
view.
• Tell the radiologist what is missing.
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