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SAFETY
Policy into practice
To improve your counting practices, start with a sound policy. You
can't go wrong using AORN standards as a foundation. They recommend 2 people — the circulating nurse and a surgical tech — conduct
a manual count concurrently, visibly and audibly.
Because the aim is to reduce variability and create a consistent
process, carry out the steps in a prescribed order. A policy should outline which items you need to count — anything that could potentially
be left in the body — and the manner and sequence in which you're to
count them (such as, start at the field and move outward, sponges
first).
The policy may even include specialty-specific counting guidelines,
as different procedures may need, or not need, different preventive
precautions. Is it necessary to count all instruments after an eye case,
for example? Or, because a bladder cystoscopy is performed through
the urethra, the likelihood of leaving unnoticed items behind seems
pretty slim.
You want your policy to be thorough and routine, but not onerous. It
should provide safety, but not make it such a burden that your staff
eventually stops following it when you're not watching.
We found that counting bags are a valuable, low-tech way to keep
track of sponges that have been discarded from the sterile field. As
seen in the photo above, a single-use, see-through plastic, pocketed
bag hangs from an IV pole, allowing a visual running tally of discarded
sponges. These bags can add a lot of efficiency to counts if they're
filled throughout surgery, and staff don't wait until the end of a procedure to bag the sponges.
Your counting policy shouldn't neglect instructions on what to do in
the event that a closing count comes up short. If the item isn't found
on the field, or on the floor, or in the trash, an all-points-bulletin usually
N O V E M B E R 2013 | 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
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