5 Ways OR Leaders Can Help Prevent Retained Surgical Items (RSIs)

When it comes to retained surgical items (RSIs), there's no single way to pinpoint why they happen—or how to stop them. That's why perioperative leader Barbara Lee Nalley, MSN, RN, ANP-BC, NP-C, CNOR, RNFA, describes RSIs as the result of "a perfect storm."

From Nalley's perspective, many factors can contribute. An emergent procedure. Inexperienced OR staff. Patients with higher BMI. Multiple procedures during the same case. Any one of these can increase risk. Together, they create conditions where small breakdowns can turn into serious harm.

While the causes are often interconnected, Nalley points to one constant that can help interrupt that storm: communication.

"The majority of RSI cases occur due to poor communication... even with the most experienced staff members in the OR," she said.

Nalley will take a deeper look at RSI causes and share practical prevention strategies during her education session at the AORN Global Surgical Conference & Expo this April. Ahead of that session, she's speaking up now to highlight what can be done to reduce risk, starting with the role leaders play.

Ways OR Leaders Can Help Prevent RSIs

OR leaders must be vocal and consistent in advocating for RSI prevention in their ORs, Nalley says. Here are a few simple, effective steps leaders can take to support safer practice.

1. Establish a standard counting policy and procedure and stick to it.

Most reasons for an RSI come down to some change in the way the count occurred and "standardization is a tried-and-true way to prevent variability leading to RSI."

2. Conduct an RSI prevention in-service yearly.

Requiring team training on standardized RSI prevention practices keeps every team member on the same page and creates opportunities to shore up knowledge gaps.

3. Perform routine room audits.

Don't rely on in-service education alone to reinforce RSI prevention. Instead, tag a peer on a rotational basis to do a surprise audit of how the team is counting without letting them know that is what you are doing. This can help to catch variances from standardized counting.

4. Leverage counting tools.

Use whiteboards, standard count sheets, sponge bag counters or adjunct technology such as RFID scanning—whichever tool works best for your team to count accurately. And keep these tools consistent—different counting tools across ORs can increase variability that opens the door to RSIs.

5. Create a "perfect storm simulation" and have teams identify the issues they see.

Get your team involved in creating or reviewing the underlying causes for RSI and review this against the elements of your policy designed to catch these causes before they happen.

How Leaders Can Jumpstart RSI Prevention Work

RSIs aren't a new topic. For many teams, that can make it harder to start a fresh conversation about prevention. Nalley says leaders may need a compelling way in.

One approach: share the story of a patient harmed by an RSI.

"Discussing how an RSI harmed a patient and their quality of life, as well as the potential legal ramifications for the staff member and facility involved, can help change the common mindset that RSI won't happen on their watch," she said.

Once the team is engaged, Nalley advises reviewing your facility's policy together.

"The more engaged your team is, the more likely they will be inclined to implement RSI prevention practices to keep patients safe," she added.

Get more RSI prevention insights from Nalley during her education session at AORN Global Surgical Conference & Expo on "The Perfect Storm: Why Do We Still Have Events with Retained Surgical Items?"