O C T O B E R 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 7 7
discharge. An exam is done, the sponge is found and thrown away, and the case
goes unreported. The same can happen after pacemaker placements in cardiac
cath labs. If no sponge management practice is in place, you can't expect to pre-
vent retained sponges.
• Correct-count retention cases. These account for about 70% of all retention cases
and are always surprising, because everyone thought everything was OK.
Surgical counts were performed, the surgeon may have performed a sweep, and
at the end of the operation, the count has been called correct. But there's a
sponge in the patient. Clearly, both the surgeon and the nurses have made mis-
takes. And ultimately, the sponge may be found hours, days, months, or even
2. As sponges are used and thrown into kick buckets, put
them into the sponge holder, one sponge per
pocket. Fill the pockets throughout the procedure.
(Incidentally, pockets with blue backs are safest. With
clear plastic pockets, if you have one holder in front of
another, it can be hard to tell which pockets contain
sponges.)
3. The surgeon must always do an MWE (not just a
"sweep") before closing the wound. (This includes the
vagina after any kind of vaginal procedure.)
4. At the end of the case, all used and unused sponges
are put into the pockets of the sponge holders.
5. Since each holder has 10 pockets and all sponges are
used only in multiples of 10, it's easy to see if a sponge is
missing. There will be an empty pocket.
6. Before leaving the OR, the circulating nurse and the
surgeon must look at the holders to be sure no pockets
are empty. This is the "show me" step.
7. The "show me" step can also be done during the
debriefing, as part of the surgical checklist.
8. The "incorrect-count checklist" should be mounted on
the wall in every OR, so team members know what to do
if a sponge is missing.
9. If the sponge isn't found, X-rays are obtained and a
radiologist must call back to the OR after reading the
image. Only a radiologist can call an image negative.
10. No stable patient leaves the OR until the sponge is
found.
The NoThing Left Behind website
(nothingleftbehind.org) provides additional detail and
includes a policy, practice manual, training video, OR
signs and posters that can be downloaded and printed.
— Verna C. Gibbs, MD
