Incorrect Surgical Counts: A Potential for Retained Surgical Items

Abstract

Background: In the main operating rooms of a large academic hospital there was a report of 408 count discrepancies in 2015-2016 and 13 incidences of retained surgical items (RSIs). There was a lack of a consistent and standardized surgical count process among nurses.

Objectives: To reduce count discrepancies by 25%, prevent RSIs, and improve the compliance of the perioperative nursing team regarding the surgical count process.

Methods: An evidence-based quality improvement project with a sample of 455 surgical procedures and 118 nurses. Data collection occurred over an eight-week period in 2018 using a Plan-Do-Study-Act (PDSA) methodology to study the effectiveness of the utilization of the Association of periOperative Registered Nurses (AORN) practice guidelines for the prevention of RSIs.

Results: The inclusion of risk reduction strategies such as the utilization of an AORN guideline whiteboard to record surgical items and the identification of high-risk items for retained device fragments or high-risk surgical items for RSIs resulted in the reduction of incorrect surgical counts by 71.43%, with no incidence of RSIs. Further, nurse compliance on surgical count practices improved significantly, F (5, 46) = 2.47, p = .046, PES = .21.

Conclusion: The implementation of the AORN guidelines for perioperative surgical count practices by the perioperative nursing team provided an improved surgical count process.

Implication for nursing: A system approach to performance improvement is needed to prevent RSIs.

Keywords: retained surgical items; surgical counts.