Minimizing distractions during initial and closing counts is one of
the best ways to prevent retained items. It's best to create a "no inter-
ruption" zone, where nurses and surgical techs conducting counts are
left to focus only on the task at hand. The initial count should take
8 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 • M A R C H 2 0 1 7
ble) so that the surgical team is not rushed through the process of
locating the missing items.
• Conduct all-in search. The circulating nurse calls for assis-
tance from everyone in the room and works with the scrub person
to organize the counted items and search the field for the missing
item. All team members must remain in the OR in case the missing
item is stuck to their shoes or clothing and so they can help in the
search.
• Recount. If you find the item, include it in a recount. If the
recount is correct, wound closure can resume.
• Perform an intraoperative X-ray. When the item remains
missing, the surgeons and a radiologist can perform an intraopera-
tive X-ray to determine if it's still in the surgical wound. If the X-ray
locates the item, the surgeon assesses the risks and benefits of
going back in to remove it. If the item is still missing after the X-ray
is performed, the surgeon must speak with the patient about the
health risks involved and the options for follow-up care.
• Conduct a root cause analysis. A root cause analysis is
required whenever a retained surgical item occurs, but it's also a
good idea to perform one after near-misses in order to assess
system errors and find out exactly what went wrong. Were surgi-
cal team members distracted? Why didn't someone speak up? The
goal is to improve protocols that would prevent a similar mistake
from occurring — or almost occurring — again.
— Mary C. Fearon, MSN, RN, CNOR
