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Counts/Retained Surgical Items

Get clinical answers to frequently asked questions about counts and retained surgical items.
  • When is an item considered to be retained?

    Reporting requirements for retained surgical items vary among quality organizations and accreditation bodies. Events that necessitate reopening a wound to retrieve a RSI should be reported in compliance with your policy, as well as local, state and federal regulatory agencies.

    Resources:

    • Guideline for Prevention of Retained Surgical Items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

    Updated December 2, 2015.

  • Is the count incorrect if there are extra items?

    Yes, the initial count may have been miscounted and the count is not valid. Discrepancies can be a result of miscounts (e.g., incorrect baseline count, overcount, undercount), documentation errors (e.g., addition), or misplaced items (e.g., retained). The count should be reconciled according to the facility’s policy and procedure for resolving count discrepancies.

    Resources:

    • Guideline for Prevention of Retained Surgical Items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

    Updated December 2, 2015

  • Does it matter which order we count items?

    The health care organization should establish the sequence in which the counts should be conducted (e.g., order of standardized count board or sheet, proximal to distal from the patient). The collective evidence supports using a standardized, consistent counting methodology.

    Resources:

    • Guideline for Prevention of Retained Surgical Items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

    Updated December 2, 2015

  • Should we count sponges by 1-10 or 1-5?

    Packaged items should be counted according to the number that the item is packaged in. Counting to the number that items are packaged in allows perioperative team members to identify packaging errors and may serve as an indication of a miscount.

    Resources:

    • Guideline for Prevention of Retained Surgical Items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

    Updated December 2, 2015

  • If we have multiple procedures for the same patient, should we count the items together or separately?

    For multiple procedures or sterile fields, all items should be counted together at the final count while sterile technique is maintained. Multiple procedures or sterile fields increase the risk of counted items moving between setups and creating confusion during counting, which may contribute to counting errors if items are missed. Counting items across all sterile fields, while maintaining sterile technique, accounts for all surgical items in the room and validates that the items have not been retained in the patient.

    Resources:

    • Guideline for Prevention of Retained Surgical Items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

    Updated December 2, 2015

  • Is the count correct or incorrect when the patient leaves with packing?

    When radiopaque surgical soft goods are intentionally used as therapeutic packing and the patient leaves the OR with this packing in place, the number and types of items placed should be documented in the medical record as:

    • reconciled and confirmed by the surgeon when this information is known with certainty or
    • as incorrect if the number and type of sponges used for therapeutic packing is not known with certainty.

    Resources:

    • Guideline for Prevention of Retained Surgical Items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

    Updated December 2, 2015

  • If a RN circulator and scrub person count an instrument tray prior to sterilization, can this count as a first instrument count?

    No, the initial count should still be performed when opening the set for use. If you are unable to count for an emergency procedure, then your facility should determine if this meets criteria for a "waived" count. If your facility decides to have the RN and tech count prior to sterilization as an additional prevention measure, you should still attempt to count the instruments in the room for the initial count if feasible. If you are not able to count due to the clinical situation, you should follow your facility's policy for waived counts and take any additional measures per policy.

    Resources:

    • Guideline for Prevention of Retained Surgical Items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

    Updated December 2, 2015

  • Should prep sponges be radiopaque?

    If gauze sponges are used for vaginal antisepsis, the gauze sponges should be radiopaque and counted. For antisepsis other than in the vagina, non-radiopaque gauze sponges may be used, but should be isolated from counted radiopaque sponges to avoid confusion. For most procedures, foam sponges are used for antisepsis rather than gauze sponges, and there is no recommendation for these types of sponges to be radiopaque or counted.

    Resources:

    • Guideline for Prevention of Retained Surgical Items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

    Updated December 2, 2015

  • Does AORN recommend performing the initial count before the patient enters the room?

    Yes, the initial count should be conducted before the patient enters the OR or procedure room, when possible. Performing the initial count before the patient enters the room will allow the perioperative team members to have the optimal benefit or reduced interruption from patent care distractions. When conducting the initial count before the patient enters the room is not possible, a second RN circulator may assist the primary RN circulator.

    Resources:

    • Guideline for Prevention of Retained Surgical Items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

    Updated December 2, 2015

  • Do we have to recount if we are interrupted during the count?

    If the count is interrupted, the count for the type of item being counted during the interruption (e.g., laparotomy sponge) should be restarted. The surgical count is a critical phase of the procedure during which distractions, noise, and unnecessary interruptions should be minimized. The collective evidence recommends that minimizing distractions, noise, and interruptions in the OR creates a safer environment for patients and perioperative team members. During the count, a no-interruption zone should be created that prohibits nonessential conversation and activities, including rushing the count.

    Resources:

    • Guideline for Prevention of Retained Surgical Items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

    Updated December 2, 2015