Surgical Count Implementations in the Operating Rooms: An Example from Turkey

Abstract

Journal of Surgery IntroductionOperating rooms, due to their complex structure and crowdedness and cases that can change suddenly, are the surgical units where unwanted incidents can occur frequently [1]. Forgetting a sponges and instruments in the surgical field is one of these unwanted incidents that may occur in an operating room [2,3]. Forgetting a sponges and instruments inside patient's body, is not a medical error but a preventable incident [4,5]. Studies demonstrate that the rate of forgetting a surgical sponges and instruments inside a patient's body, ranges from 1/1,500 to 1/19,000 [5,6]. American Surgical Association stated that retained surgical instruments case is occured at least once a year in each hospital and significant procedures are applied for 8,000 and 18,000 of these [7,8]. Retained surgical instruments cases mostly happens in the surgical field of abdomen (46-55%), but also pelvis, chest, and vagina can be included in this category [5,9]. The frequency of retained foreign objects cases ranges from 1/1,000 to 1/1,500 in abdominal and pelvic surgery. Although it is not frequent, retained foreign objects cases is found in orthopedics, urology and neurologic operations [5].During the course of surgery, everthing which can cause a reaction in patient, can be identified as foreign object. Within this scope, the most frequent retained surgical instruments are, sponge that ranks first and followed by surgical instruments, ecarteur, needle and compress [3,9,10]. Furthermore, broken surgical instruments, rubber tubes, and AbstractAim: Although retained foreign bodies are a rare and preventable problem, it is one of the medical errors in surgery can have heavy medico-legal consequences. Retained sponges can cause significant morbidity, prolonged hospital stay, postoperative complications, pain and disabilities. Also the costs associated with treatment of retained surgical items can be considerable. The study was undertaken to determine the current implementations related to instruments and sponges counts in the operating rooms in Turkey.Method: This descriptive study was carried out with 261 operating room nurses. The data collection tool was a questionnaire which was designed on the Google Drive application using the internet. Thereafter its internet link was distributed throughout Turkey using nursing, surgical nursing and operating room nursing social media websites; the answers were gathered in the same way.Results: Ninety-five percent of participants stated that instruments and sponges were usually counted by the scrub nurses (88.5%). Sponges (97.7%), pads (95.4%), tampons (89.2%), surgical instruments (88.1%) and needles (70.4%) were the items which were usually counted. According to 81.6% of the nurses, a written count protocol exists for their hospitals, however, they noted there was a significant difference in implementation among the various institutions (p=0.026). While 49.8% of participants stated that the count before surgery was done by nurses, 23.7% reported that the count was perfor...

A description of Surgical counting safety practices among operating room nurses and midwives in Rwanda

“…Although World Health organization(WHO) and the Association of periOperative Registered Nurses (AORN) recommended that counting of surgical items would be performed for every surgical procedure (3) (11), similarly to the study(4), the respondents affirmed that surgical item count was performed in certain procedures such the abdomen surgeries as the abdominal size can lead to surgical objects cases' retention (4). Therefore, the observation that was done in different types of surgical procedures as the study done in the Iran on "Three years evaluation of retained foreign bodies after surgery" showed that unknown items retained in everybody hollows were included peritoneal hollow, thoracic cavity, gastrointestinal zone, urogenital tract, facial region, abdominalpelvic area with the majority of abdominal and peritoneal cavities(55,26%) and chest cavities(18.42%) (12).…”

“…Regionally, in one European Country such as Portugal, Maria and Paulo (2016) highlighted that the surgical counting process is considerably related to clinical organization and the existence of surgical counting technology as well as other methods of surgical counting (3). In Asia, the Turkish researchers worked on the surgical count implementation in the operating room and realized that standardized surgical count procedures are available and almost all incidents regarding the retention of surgical swab or instrument occur in abdomen surgeries, moreover some unprepared surgical interventions, existence of many theatre team members in operating room, procedures periods and complicated procedures are also taken in action (4).…”

Kirurgisk telling som verktøy for sikker pasientbehandling ved kirurgi: En kvalitativ studie av operasjonssykepleieres erfaringer

“…Studier som undersøker operasjonssykepleieres erfaring og innsats for å minimere risikoen for den uønskede hendelsen er en mangelvare (30)(31)(32). Operasjonssykepleierne er i nøkkelposisjon for å identifisere trusler mot pasientsikkerheten ved å kontinuerlig identifisere risikofaktorer og forebygge at pasienten utsettes for skade perioperativt (6,33,34). Kang et al (33) fremhever at det er sammenheng mellom operasjonssykepleierens ikke-tekniske ferdigheter og pasientsikkerhet.…”

“…Ulike system med hensyn til oppdekking kan også skape forstyrrelser i teamsamarbeidet og forårsake tellefeil. For eksempel kan personalskifte der avløseren må omorganisere til «eget system» skape en situasjon med tap av orden og kontroll over kompresser og redskaper (6,45,46). En aktuell løsning her er å innføre standardisert organisering av redskaper på instrumentbordene.…”

“…WHO anslår at kirurgiske redskaper blir gjenglemt ved 1 av 1000 operasjoner (3). Alle typer redskaper som anvendes under operasjonen kan gjenglemmes i pasientens kropp og føre til pasientskade og reoperasjon med forlenget sykehusopphold som konsekvens (4)(5)(6). I noen tilfeller kan gjenglemt fremmedlegeme føre til alvorlig sykdom og død (7)(8)(9).…”