Chapter 12: Surgical Case Management; Ordering: Prevention of Foreign Body Retention Counts

Prioritize the sequence of counts correctly (1-4)

1) Sponges X-ray detectable (Ray-Tec, laps, tonsil sponges, Kitners, cottonoids, etc.)

2) Sharps - suture needles, blades, hypodermics, ESU tip (Note: Some policies include another category of "miscellaneous" items small enough to be lost in the wound, such as suture boots, vessel loops, "Bovie" scrapper, etc.)

3) Instruments (tray 1, tray 2, etc., extra parts counted, then added items)

4) Dressing sponges accounted for

Read each statement in this scenario and prioritize the order of counts to be completed. (1-7)

1) When all items required on preference card are added to field.

2) The scrub nurse is relieved just after the initial incision.

3) Additional items added during delivery of the placenta (procedure) prior to any closing counts.

4) Closure of hollow organ (e.g. uterus).

5) Closure of cavity (e.g. abdominopelvic).

6) Closure of fascia or layer before subcutaneous tissue.

7) Closure of skin is initiated.

Identify the flow of the closing counts from first to last. (1-8)

1) Items in use at sterile field

2) Items on Mayo stand

3) Kickbucket

4) Back table

5) Surgeon notified something missing

6) Recount starting at sterile field

7) Room search including trash

8) X-ray taken

Identify the correct order for the counting process. (1-8)

1) Break the tag/band or remove stringer, keeping items together.

2) Verify that circulator can see item.

3) State the name of the item to be counted.

4) Separate items completely as they are counted for visualization

5) Verbalize the numbers on count sheet or board.

6) Repeat the total at the end of the count.

7) Circulator repeats the count.

8) Circulator records the number on count sheet or board.

Identify how items are placed on the Mayo stand. (1-7)

1) Prepare a towel roll/instrument stand.

2) Mentally review the steps of the procedure and identify instruments likely to be used.

3) Prepare a mental picture of final Mayo setup and move the item one time into place using that mental picture.

4) Inspect instrument(s) as chosen- cleanliness, damage, and function.

5) Close items on first ratchet and place on towel roll in even numbers.

6) Place additional sponges, dissecting sponges, suture, ligatures, prepared hypodermic syringes with local, etc.

7) According to hospital time-out policy, place prepared scalpel on Mayo stand (in this scenario after the time out).