7 6 S U P P L E M E N T T O O U T P A 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 5
medical record. Note that roughly 80% — the first 2 types — are the result of
practice failures:
• No-count retention cases. These account for about 10% of retained-sponge cases
and usually happen when no policy requires sponges to be counted and physi-
cians don't perform wound exams. For example, most perinatal birthing rooms
use gauze dressing sponges and don't have sponge-management practices.
Sponges used in vaginal births should contain radiopaque markers – surgical
sponges – and there should be practices to account for them. But because prac-
tices are faulty or non-existent, the vagina is the 2
nd
most common site for
retained sponges (the abdomen is first).
The classic case is a new mother who seeks medical attention for a vaginal
Surgeons, nurses and radiologists are the 3 most
important defenders against retained sponges, and all
have specific responsibilities. The surgeon's job is to
always do a methodical wound exam (MWE) before
closing. The nurse's job is to keep track of the sponges
added into the case and to determine with certainty
that all are out at the end. The radiologist's job is to
obtain X-rays in the OR when needed and to provide
radiographic interpretation.
The Sponge ACCOUNTing System is a standardized,
transparent, multi-stakeholder, manual sponge-man-
agement practice designed by the NoThing Left Behind
project. It requires sponge holders, which are very inex-
pensive and widely available. Each has 2 rows of 5
pockets, so each holds 10 sponges. Here are the most
important steps:
1. Keep a count of the sponges in multiples of 10 on a
dry erase board everybody can see. Use a standardized
format throughout all rooms in the OR suite.
NEW APPROACH
10 Steps to Accounting for All Sponges
z EASY MATH The Sponge
ACCOUNTing System shows at a
quick glance that 50 sponges were
opened and 50 are accounted for.
Verna
C.
Gibbs,
MD
