nurses should update the count noted on the whiteboard.
• Scrub techs. They must maintain an organized sterile field and
have an ongoing awareness of where counted items are during sur-
gery. There are documented reports of instrument fragments remain-
ing in patients after surgery, so surgical techs must also inspect all
instruments and make a mental note of their condition so they can
recognize if screws or parts are missing when the surgeon returns
them after use. At the end of the case, the scrub tech teams with the
circulating nurse to perform the closing count.
• Surgeons. They must ensure they use only radiopaque items in
the wound, maintain an awareness of those items in the surgical field
and communicate with the surgical team about which items are being
placed in the patient. At the end of the case, and before closing, the
surgeon should perform a methodical visual sweep of the wound and
feel around to ensure no items remain. The surgeons should also noti-
fy other team members if items are intentionally left in the wound as
packing material. They should verify and document the results of the
final count.
• Anesthesia providers. They should coordinate their care so as to
not rush the surgical team through the counting process. For example,
the patient shouldn't be emerging from anesthesia when the count is
underway. Anesthesia providers must also be responsible for account-
ing for and removing throat packs and bite blocks, which are both sur-
gical items that have been left in patients. Here's a suggestion: Have
anesthesia providers wear a wristband that notes "Throat Pack" or
"Bite Block" as reminders to remove the items before patients leave the
OR.
Additional help
Detection and counting technologies — handheld scanners that count
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