So, yes, record one count before starting the next. That's just one of
the many lessons AORN gleaned from psychological studies on count-
ing that helped shape its updated Guideline for Prevention of
Retained Surgical Items.
"You have multiple objects to count: sponges, sharps, instruments. We
don't want people trying to remember how many sponges there were
while they're counting needles," says Amber Wood, MSN, RN, CNOR,
CIC, FAPIC, senior perioperative practice specialist with the
Association of periOperative Registered Nurses (AORN) in Denver,
Colo.
When Ms. Wood searched for evidence-based studies on counting in
surgery to support AORN's updated retained items guideline, she
came up empty. "We simply do not have counting studies in the OR,"
she says.
But when she expanded her search, she happily discovered several
studies on the psychology of counting — enumerating to researchers,
not counting. It was just the sort of evidence-based research Ms. Wood
knew could help shape how and when to count in the OR and lower the
incidence of retained surgical items.
For example, multitasking — the act of doing more than one thing
at the same time, such as remembering and counting — is largely an
illusion. You can't do it, at least not well. Researchers believe there is
a processing bottleneck in the brain. "You're concurrently using your
memory as you're counting, and counting takes up memory," says Ms.
Wood. "When our brains switch between counting and remembering,
we make transcription errors."
Studies have also shown that you can't count accurately beyond 2
when you're distracted, which, in the hustle and bustle of the operat-
ing room, explains why foreign objects may be retained after surgery
twice as often as the government estimates, or up to 6,000 times a
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