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SAFETY
involves a call to radiology and fluoroscopic imaging of the site.
Radiology plays an important role in prevention response, so don't
leave them out of the drafting or training of the policy. Through interactions with nurses, they can learn what a retained sponge or other object
looks like on the screen.
While the majority of surgical instruments include radiopaque metal
components and will readily show up on an X-ray, it's important to
remember that smaller plastic pieces, like some parts of a laparoscopic
stapler, might not. For visibility's sake, many surgical facilities now
stock towels and lap sponges with tags, bar codes or chips that enable
detection by imaging or scanning devices.
Another tip for seeing the unseen: When the
radiology tech arrives in the OR, don't tell him what item is missing
from the count. That'll limit what he's looking for. Just say, "We're
missing something," and let him scan. I remember hearing about a situation at another facility in which a nurse reported a missing clamp at
closing. The radiology tech's sweep didn't find a clamp. But it also didn't find the missing sponge beneath the patient's liver.
A word on technology
Recent years have seen the rising popularity of electronic sponge management systems (tinyurl.com/nbpx2cr). But the proper role of technology in
counting should be verification only: an adjunct safeguard to confirm the
accuracy of your manual sponge counts. When we set out to improve
our process, we felt that even in light of the available technology, the
human factor was important to keep. Admittedly, scanning the bar codes
on sponges to count them into and out of the sterile field added another
step, and admittedly staff's initial reaction was mixed. As they got used
to it, though, they've been more accepting of this validation step. Keep in
mind that in most instances of retained objects, the count was docu2 4
O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | N O V E M B E R 2013
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