Outpatient Surgery Magazine

No Guarantees - March 2017 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 87 of 138

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

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