Using Adjunct Technology with the Surgical Count

Clinical Tips and Tricks Developing Your Skills The Stitch

By: Sara Angelilli, DNP, MS, RN, CNOR, NPD-BC

Published: 1/9/2025

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The surgical count is a critical process for patient safety. Sentinel event data from The Joint Commission identifies unintentionally retained surgical items (RSIs) as the third most common event type in 2023.1 In one study, 1,430 contributing factors were identified across 13 categories in a review of 319 occurrences of retained surgical sponges.2 Human factors, leadership, and communication were the most common contributing factors for retained sponges.2 In the 319 cases reviewed, a sponge count was performed in 77.4% of reports, with the count reported as correct 80.6% of the time.2  

    Errors

    Manual surgical counts are prone to problems because the surgical nurse functions in a complex environment with distractions, interruptions, and cognitive fatigue.3 Distractions, noise, multitasking, and interruptions interfere with attention during surgical counts.3,4 The sensitivity of manual surgical counts and radiography for detecting an RSI is 77.2% and 67%, respectively. In contrast, the sensitivity of radiofrequency (RF) adjunct technology for detecting an RSI is 98.1% (mats) and 100% (wands).4 AORN advocates for a systems approach to prevent RSIs, including standardized counting and reconciliation procedures, methodical wound exploration, radiologic confirmation, adjunct technology, and teamwork training.4 

    Adjunct Technology 

    Radiofrequency, radiofrequency identification (RFID), and data matrix tags are examples of adjunct technology used to detect retained surgical sponges. Literature describing the implementation of RF adjunct technology reports decreased or eliminated retained surgical sponges after implementation.4 RF technology uses wands or mats to scan the patient and detect the presence of RF chips embedded in the surgical sponges. In contrast, data matrix tags are two-dimensional codes that are scanned by a barcode reader to account for surgical sponges. 

    Considerations for Using Adjunct Technology 

    Important considerations for the successful use of adjunct technology include following the manufacturer’s instructions for use (IFU) and the facility’s policy for counting. When the IFU or facility policy is not followed, there is an increased risk for RSIs. AORN recommends using adjunct technology even when the surgical count is correct and documenting the use of adjunct technology in the medical record. Of note: RF and RFID devices should be used with caution in patients who have pacemakers, implantable cardioverter defibrillators, or other implanted electronic devices because the RF and RFID devices can interfere with the electronic medical devices. 

    Other important considerations when using adjunct technology include to 

    • never cut surgical sponges or alter the adjunct technology tag; 
    • if the RF tag or data matrix tag becomes damaged or is missing during the surgery, remove the sponge from the sterile field and account for it in the sponge counter bag; 
    • when using data matrix technology, only scan sponges once they are removed from the surgical field; and 
    • complete the manual surgical count and use the adjunct technology before the surgical wound is closed. 

    References 

    1. The Joint Commission. Sentinel Event Data 2023 Annual Review. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/2024/2024_sentinel-event-_annual-review_published-2024.pdf. Accessed October 5, 2024. 
    2. Steelman VM, et al. Retained surgical sponges: a descriptive study of 319 occurrences and contributing factors from 2012 to 2017. Patient Saf Surg. 2018;12(20).  doi:10.1186/s13037-018-0166-0 
    3. Bubric K, Martel J, Laberge J, Litvinchuk S. Factors contributing to incorrect surgical counts and system-based prevention strategies. ORNAC J. 2019;37(4):13-38.   
    4. Guideline for prevention unintentionally retained surgical items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2024. 

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