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Like most hospitals, we use strict manual counting protocols in our operating rooms to account for all surgical items. Historically, if a count was off and a piece of gauze or a sponge was unaccounted for, nurses were forced to search under the surgical table or rummage through the trash to find it. If the missing item could not be found, sometimes an X-ray would be ordered to locate it. This traditional response to an unreconciled count was both ineffective and inefficient. The process exposed the patient to additional radiation and time under anesthesia.
Even an apparent correct count is no guarantee against a retained object. In fact, most retained incidents occur as a result of a miscount. Our physicians and nurses are among the best in their field, but they are human, and research has attributed 80% of patient care errors to human factors. When a patient is rushed through our doors in an emergency or trauma case, the OR quickly becomes chaotic, causing no-time-to-count scenarios or counting errors.
Enter technology
Surgical detection systems protect against the risks for retained objects. They safely and accurately read through deep cavity tissue, fluids and bone to detect if radiofrequency-tagged materials remain in a patient after surgery. The latest version of the technology includes an automatic detection mat that lets staff scan the patient with the push of a button. When a manual count is completed, staff can quickly determine accuracy through secure automatic verification. When the count indicates that an item is missing, the wave of a wand or automatic mat scan can find it, notifying staff with a visual and audio alert.
The hands-free component of the system is especially useful in trauma cases, as surgical items can be identified without interrupting staff workflow. The sensitivity and specificity of the technology is also particularly valuable in bariatric procedures, as patients with higher body-mass index are at greater risk for a retained object.
Is counting alone sufficient?
According to AORN's recommended practices, counting alone is insufficient to prevent retained sponges. Consistent with the literature, AORN's current guidelines in-clude a recommendation that perioperative nurses evaluate technology to assist with the surgical count.
My hospital has not only led in early adherence to the revised AORN guidelines, but also is participating in the clinical evaluation of adjunctive technology to prevent retained objects. Interim results of the study show that:
- Retained items occur regardless of whether the manual counts were correct, affirming the need for a verification process with adjunctive detection technology.
- Radiofrequency detection speeds identification and avoids use of radiation to locate missing sponges, thereby improving patient safety as well as clinical efficiency in the operating room.
- In almost 90% of operations, nurses reported that radiofrequency detection resulted in less stress during wound closure and improved overall surgical team confidence that no surgical items were left in the patient.
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COMMON MISTAKE?: 2,000 "Never Events" a Year |
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The problem of leaving material such as a piece of gauze or surgical sponge inside a patient after the procedure is complete is universally recognized, yet little data is available on how often it occurs. What data exists typically is obtained from malpractice claims. If we go by the lawsuits, it's estimated that 1,500 to 2,000 retained object cases occur each year in the United States. What we know for sure is that a retained object has significant ramifications for both patient and provider. Patients may present with complications such as post-procedure infection, bowel perforation and abscess that may even result in death. When a retained item incident occurs, there is often need for additional surgical procedures, medication and ongoing care. Not only is the patient's health threatened, but also they are delayed in recovering and returning to their daily lives and may incur added healthcare expenses. The Centers for Medicare & Medicaid Services has named retained objects a "never event" for which there is no reimbursement for providers. The cost of this error to a hospital can be staggering. CMS estimates the cost of a retained object after surgery to be $62,631 per hospital stay. In actuality, the total is likely much higher, as this figure doesn't take into account the litigation and settlements providers may face when a patient takes legal action (see "Jury Orders Surgeon to Pay Over Half a Million in Retained Object Case" at tinyurl.com/8xkrzb8 and "Is a Surgeon Responsible for Retained Objects?" at tinyurl.com/83dyot2). Moreover, because the current healthcare landscape has become increasingly competitive, a well-publicized retained object incident can wreak untold damage on a surgical facility's reputation in terms of public trust and, ultimately, its bottom line. — Lynn Bridgewater, MSN, RN |
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