Risk factors for incorrect surgical count during surgery: An observational study

Abstract

Background: Incorrect surgical counts are closely related to retained surgical items, which pose a threat to patients. However, the risk factors for incorrect surgical counts have not been identified yet.Aim: To identify the risk factors associated with incorrect surgical counts during surgery in a tertiary hospital.Design: An observational case-control study.Methods: Seventy cases of incorrect surgical counts were reviewed in this study.Data were collected from January 1, 2014, to April 4, 2019. For each case, we included four randomly selected control cases involving the same surgical procedures by the same surgeon within a 6-month period for comparison. The medical data of these cases were extracted for further statistical analysis.Results: A higher incidence of incorrect surgical counts was observed among surgical counts performed between 8:00 a.m. to 12:00 a.m., emergency operations, prolonged procedures, and/or after addition of surgical items. Conclusion:Prolonged surgical procedures, emergency operations, time of occurrence, and addition of surgical items were the risk factors related to incorrect surgical counts during surgery.

Surgical counting: design of implementation and maintenance of a standardized evidence-based procedure

“…Evidence for surgical counting is currently available and there are many discussions and efforts towards implementing best practices ( 1 , 2 , 3 , 4 , 5 , 6 ) . To this end, institutional documents must be prepared in order to standardize the time to carry out the counts, the form of registration, actions to be taken in discrepant count and the relevant flows involved ( 6 ) .…”

“…Currently, manual counting is the main one performed in most hospitals, and needles are known to be the least counted items ( 3 ) . Standardized procedures for surgical counting should be widely disseminated and rigorously complied with between teams, including registration, conference by at least two people (one donned, checking in the operative field, and another off the field, usually the circulator) and at least two moments (when items are included in the field and at the end of surgery) ( 4 ) . For discrepant counts, before closing the operative wound, after a second count, a radiograph can be performed to identify the item in the cavity ( 4 ) .…”

“…Although there is evidence available in the literature for best practices, it is still a challenge for surgical centers to ensure the correct counting of surgical items ( 1 - 4 ) . Multidisciplinary engagement is a significant challenge, since, for successful counting, the entire surgical team must be involved, and nursing professionals have a leading role in favor of patient safety with the safe execution of the counting process ( 4 ) .…”

Contagem cirúrgica: projeto de implementação e manutenção de um procedimento padronizado baseado em evidências

“…Atualmente, a contagem manual é a principal realizada na maioria dos hospitais, e sabe-se que as agulhas são os itens menos contados (3) . Procedimentos padronizados para a contagem cirúrgica devem ser amplamente difundidos e rigorosamente cumpridos entre as equipes, incluindo registro, conferência por, no mínimos, duas pessoas (uma paramentada, conferindo no campo operatório, e outra fora do campo, geralmente o circulante) e em, pelo menos, dois momentos (quando os itens são incluídos no campo e ao final da cirurgia) (4) . Para contagens discrepantes, antes do fechamento da ferida operatória, após segunda contagem, pode ser realizada uma radiografia para identificação do item na cavidade (4) .…”

“…Embora haja, na literatura, evidências disponíveis para melhores práticas, ainda é um desafio para os centros cirúrgicos garantirem a contagem correta de itens cirúrgicos (1)(2)(3)(4) . O engajamento multidisciplinar é um desafio significativo, visto que, para o sucesso da contagem, todo o time cirúrgico deve estar envolvido, e os profissionais de enfermagem têm papel preponderante a favor da segurança do paciente com a execução segura do processo de contagem (4) .…”