• Count, count and count again. AORN recommends counting all sponges,
sharps, and related miscellaneous items at 5 different times: (1)
before the procedure to establish a baseline, (2) before closure of a
cavity within a cavity, (3) before wound closure begins, (4) at skin clo-
sure, and (5) at the time of permanent staff relief of either the scrub
person or circulating nurse. For surgical instruments, AORN recom-
mends counting only at times 1, 3 and 5. AORN suggests you docu-
ment all counts in the intraoperative record. If a discrepancy is found
between counts, the surgical team must complete a search for the
missing item.
• Know the risk factors. Count discrepancies have been linked to surgery
duration, late time procedure and the number of nursing teams. Along
with the duration of the surgery, an inaccurate count can occur when
the surgery is particularly difficult or mentally draining. Studies have
7 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 6
AORN last month released its updated
"Guideline for Prevention of Retained Surgical
Items," which provides guidance to perioperative
team members to ensure accurate accounting
of all surgical items that could potentially be
retained in the patient. Establishing no-inter-
ruption zones and standardizing counts and rec-
onciliation procedures can reduce the risk of a
retained surgical item, says AORN. In addition to such countable surgical goods as sponges,
sharps and instruments, team members should also account for detachable pieces and device
fragments that may not be detectable in X-rays, says AORN.
Download the AORN guideline at
aornjournal.org/article/S0001-2092(15)01014-5/pdf.
SURGICAL NEVER EVENT
AORN Updates Retained Objects Guideline
• NOTHING LEFT BEHIND Retained objects not only cause irreparable harm to
patients, they also bring on costly med mal suits.
