ly summoning the powers of memory and enumeration, you should
record one count — on a standardized template in a location that's visi-
ble to the surgical team — before starting the next. That's just one of the
many lessons AORN gleaned from psychological studies on counting
that helped shape its updated Guideline for Prevention of Retained
Surgical Items (osmag.net/KRkGa4), says Amber Wood, MSN, RN,
CNOR, CIC, FAPIC, senior perioperative practice specialist with AORN.
Studies have also shown that you can't count accurately beyond 2
when you're distracted. If you're interrupted during a count, don't
resume counting but rather start over from zero, says Ms. Wood. Also,
don't start counting during critical phases of the procedure, including
the time out. Take care of patient care needs before you start the
count. Once the patient enters the room, you have an immediate dis-
traction and the patient needs 100% of your attention, so it's better to
do the initial count in the relatively quiet few minutes before the
patient enters the room. If the baseline count's not accurate, none of
the others will be accurate, says Ms. Wood.
Minimizing distractions during initial and closing counts is one of
the best ways to prevent retained items, says Mary C. Fearon, MSN,
RN, CNOR, a perioperative practice specialist for AORN. It's best to
create a "no-interruption" zone, where nurses and surgical techs con-
ducting counts are left to focus only on the task at hand. Some facili-
ties have even flashed "INITIAL COUNT IN PROGRESS" on surgical monitors
to alert the rest of the team to keep distractions at a minimum.
Finally, it's also a good idea to line kick buckets and sponge recepta-
cles with clear plastic bags. Red biohazard bags make it difficult to see
bloody used sponges, and white bags make it difficult to see unused
sponges, says Verna C. Gibbs, MD, the director of NoThing Left Behind,
a staff surgeon at the San Francisco VA Medical Center and a clinical
professor of surgery at the University of California, San Francisco.
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