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(In this second part of a two-part series, we discuss how to resolve count discrepancies. In a separate story in this issue, we discuss the importance of standardization and how to address needles. In last month’s issue, we discussed some new challenges and solutions for retained surgical items.)
When a member of the OR team notices a count discrepancy, that person must speak up,1 said Amber Wood, MSN, RN, CNOR, CIC, senior perioperative practice specialist at the Association of periOperative Registered Nurses (AORN) and lead author of a newly updated guideline on retained items.
Speaking up is the most important step, Wood said, and that person should be verbally acknowledged by the surgeon.1 A recently updated guideline from AORN includes a decision tree to guide team members who suspect a discrepancy through the count reconciliation process.1 (For information on ordering the updated guideline, see Resource at end of this story.)
Team members should discuss how many items are missing and what they are, according to AORN.1 The role of the RN circulator is to ask for assistance and search the room. The role of the surgeon and scrub person is to search the surgical site, as well as the Mayo stand and the back table, AORN says. The circulation and scrub person should do a recount, it says.
If the missing item isn’t found, the surgeon should obtain intraoperative images, according to AORN.1 Your policies should spell out what communication takes place between the operating room and radiology when imaging is performed; specifically, the reason for the imaging should be discussed, The Joint Commission says in a recent Quick Safety article on retained objects.2
The images should be reviewed by the surgeon and the radiologist at the same time, AORN says, which is a step also recommended by The Joint Commission.2 The surgeon should verify that the entire surgical site was captured by the image, AORN says. If the item still is missing, the radiologist and surgeon can consider other imaging modes, such as MRI and CT.
If the item remains missing, the RN circulator should document all the steps that were taken to try to find the object, and the surgeon should consult with the patient or patient representative regarding follow-up care, AORN says.
Financial Disclosure: Executive Editor Joy Dickinson, Nurse Planner Kay Ball, Physician Reviewer Steven A. Gunderson, DO, and Consulting Editor Mark Mayo report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Stephen W. Earnhart discloses that he is a stockholder and on the board for One Medical Passport.