Guideline Implementation: Prevention of Retained Surgical Items

Abstract

A surgical item unintentionally retained in a patient after an operative or other invasive procedure is a serious, preventable medical error with the potential to cause the patient great harm. Perioperative RNs play a key role in preventing retained surgical items (RSIs). The updated AORN "Guideline for prevention of retained surgical items" provides guidance for implementing a consistent, multidisciplinary approach to RSI prevention; accounting for surgical items; preventing retention of device fragments; reconciling count discrepancies; and using adjunct technologies to supplement manual count procedures. This article focuses on key points of the guideline to help perioperative personnel provide optimal care during a procedure. Key points addressed include taking responsibility for RSI prevention as a team; minimizing distractions, noise, and interruptions during counts; using consistent counting methods; reconciling discrepancies; and participating in performance-improvement activities. Perioperative RNs should review the complete guideline for additional information and for guidance in writing and updating policies and procedures.

Asymptomatic gossypiboma with complete intramural migration and ileoileal fistula

“…In an attempt to prevent the incidence of gossypiboma, the association of operating room nurses in 2015 proposed recommendations that consisted of counting of surgical sponges in use at various specified times during the procedure. Counts are performed before beginning the procedure, whenever additional items are brought into operative field, before the body cavity is closed, just before the wound is closed and the final count is done before the surgeon closes the skin 29 30…”

Clinical Issues—June 2018

“…• induction and emergence from anesthesia, 2,[4][5][6][7] • preoperative briefings, [6][7][8] • time outs, 2 • critical dissections, 2 http://doi.org/10.1002/aorn.12167 © AORN, Inc, 2018 CLINICAL ISSUES • surgical counts, 2,5,7 • confirming and opening of implants, 2…”

“…• going on and off cardiopulmonary bypass, and • postoperative debriefings. 3,7,8 The aviation industry exemplifies the use of enhanced efforts to reduce the potential for distractions. Similar to the surgical setting, piloting airplanes requires focus and attention to details at critical points in flight.…”

“…• wellness and resilience, as well as leaders who model organizational values, stress management, resilience, and work-life balance. 1,2,6,7 Finally, and perhaps most importantly, leaders should help ensure that the work environment maintains zero tolerance for incivility, bullying, and workplace violence. 5 Disruptive behaviors stemming from the fastpaced, high-stress OR environment are prevalent among many surgical specialties.…”

“…8 This has led to AORN's endorsement of the American Nurses Association Position Statement on Incivility, Bullying, and Workplace Violence. 7 AORN recognizes that the issue of bullying is important enough as a detriment to patient safety and to the health of perioperative personnel to take a stand. Every organization should make this a priority.…”