Standard Comparison

IFPN

AORN

ORNAC

AfPP

Count should be done for any procedure in which sponges, sharps, miscellaneous items & instruments could be retained in the surgical patient.

• Before start of procedure
• Before closure of cavity
• Before closure of wound
• Skin closure

Count performed with 2 people , one who shall be a RN, same two persons, audibly & separated

Additional items  counted immediately;

Standardized procedure for count

Sponges should be attached to an instrument if placed in a cavity, tapes not cut

Counted sponges should not be used as post op packing - documentation of intentional packing

Interrupted count must be recommenced

Counting off process

Isolation of incorrect original items;

Sponges Shall be counted on all procedures in which the possibility exists that a sponge could be retained

·         Before procedure

·         Before closure of cavity

·         Before wound closure

·         Skin closure

·         Permanent relief of either scrub or circulating nurse

Sponges should be separated, documented ,counted audibly & with 2 people;

Additional items  counted immediately;

Isolation of incorrect original items;

Standardized counting procedure;

Radiopaque items;

Not cut from original design;

Counted items should remain in the OR until final count;

Counted sponges should not be used as post op packing - documentation of intentional packing

Count should be done for any procedure in which sponges, sharps, miscellaneous items & instruments could be retained in the surgical patient.

·         Before procedure

·         Before closure of cavity

·         Before wound closure

·         Skin closure

·         Permanent relief of either scrub or circulating nurse

Count performed with 2 people , one who shall be a RN,  audibly & separated to identify radiopaque strip - twice

Additional items  counted immediately;

Standardized counting procedure;

Radiopaque items

Counted items should remain in the OR until final count;

Isolation of incorrect original items;

Interrupted count must be recommenced

Isolation of incorrect original items;

A swab, instrument and needle count should be performed  for all clinically invasive procedures.

·         Before procedure

·         Before closure of cavity

·         Before wound closure begins

·         Skin closure or end of procedure

·         Permanent relief of either scrub or circulating nurse

Count performed with 2 people , one who shall be a qualified member, same two persons, audibly & separated, multiples of 5s

Incorrect pack/swab numbers shall be removed from the area immediately

Radiopaque items used , integrity checked

Counted items should remain in the OR until final count;

- documentation of intentional packing

Interrupted count must be recommenced

Counting off process identified

Incorrect original items removed form the OR

When to count

Suture needles counted & visually verified against packet ;

Sharps passed to surgeon on exchange basis;

Use of disposable puncture resistant container to contain used sharps

Counted items should remain in the OR until final count;

Sharps & other miscellaneous items should be counted on all procedures

Description of items

When to count

Audibly & with 2 people;

Additional items  counted immediately;

Suture needles counted & visually verified against packet ;

Sharps passed to surgeon on exchange basis;

Standardized counting procedure;

Accounting for sharps or broken items responsibility of surgical team;

Counted items should remain in the OR until final count;

When to count

Suture needles counted & visually verified against packet ;

Sharps passed to surgeon on exchange basis;

Sutures shall be contained

on a needleholder ,sealed in packets or on needle counter

Accounting for sharps or broken items

Use of disposable puncture resistant container to contain used sharps

Suture needles counted & visually verified against packet ;

Sutures shall be contained sealed in packets or on needle counter

Accounting for sharps or broken items responsibility of surgical team;

Before start of procedure

Before wound closure

Individual pieces of assembled instruments should be identified;

Accounting for broken items responsibility of surgical team;

All items removed from the OR at end of case

Standardised instrument sets

Pre-printed sheets

Instruments should be counted for all procedures in which the likelihood exists that instruments could be retained.

When to count -before procedure, closure, permanent relief

Audibly & with 2 people;

Instruments should be counted  when sets are assembled but not considered first count;

Individual pieces of assembled instruments should be identified;

Additional items  counted immediately;

Accounting for broken items responsibility of surgical team;

Standardized counting procedure;

Final count not considered complete until items used in wound closure are returned to scrub;

Counted items should remain in the OR until final count

All items removed from the OR at end of case

Standardised instrument sets

Pre printed sheets

When to count-before procedure

Accounting for broken items responsibility of surgical team;

Standardised instrument sets

HCF policy identifies counting practice

Minimally invasive instruments to be counted

MI instruments need not be counted off if case did not proceed to open .

Documentation of incorrect count/action

In an emergency situation when a count cannot be performed an X-ray shall be taken

Additional measures for investigation, reconciliation, documentation and prevention of retained surgical items should be taken.

Incorrect counts - procedures

Notify surgeon & team members

    Procedure suspended

    Inspection of wound

    Inspection of OR environment

    Xray

    Documentation

    Investigation

Policy for high risk situation

Documentation of incorrect count/action

Notify surgeon & team members

Inspection of OR environment

Xray

Documentation

Investigation

In an emergency situation when a count cannot be performed an X-ray shall be taken

Incorrect counts - procedures

Notify surgeon & team members

Inspection of OR environment

Xray-discretion of surgeon

Documentation

Investigation

In emergency situation, packets shall be retained to facilitate count at earliest opportunity

Count sheet

Description of required information including those deliberately left in pt.

Documentation of omission of count

Sponge, sharp & instrument counts should be documented on the patient's intraoperative record by the RN circulator

Uniform language used

Description of information to be included

Documentation of nursing activity

Documentation of omission of count

All those involved in count shall sign the count record

Count record filed in permanent records

Documentation of omission of count

All those involved in count shall sign the count record

Count record filed in permanent records

All documentation to be completed

Responsibility  of scrub practitioner

Facilities should have a policy & procedure for surgical counts:

When, by whom, items to be counted, documentation and incorrect processes

Policies & procedures for sponge , sharps & instrument counts should be developed, reviewed periodically revised as necessary, and readily available in the practice setting.

Direction of what is required in a policy

Policies should be included in orientation

Organ procurement should be included

Facilities should have a policy & procedure for surgical counts:

When, by whom, items to be counted, documentation and incorrect processes

Routine audits

Policies should be included in orientation

Results of counts shall be announced audibly to the surgeon and verbal acknowledgement received

Results of counts shall be announced audibly to the surgeon and verbal acknowledgement received

Results of count shall be verbalised by the scrub nurse with verbal acknowledgement by the surgeon

In event of wound re-opening, the final count shall be taken again

In event of wound re-opening, the final count shall be taken again

Registered Nurse is identified as accountable for counts during surgical procedure

The Count shall be the responsibility of the scrub and circulating perioperative registered Nurse(s)

If items intentionally left in - surgeon assumes responsibility for removal

If no count required circulating nurse & surgeon should conduct count

If no count required circulating nurse & surgeon should conduct count

A separate count sheet is required for each surgical instrument set-up, no exchange of instruments should occur

Final count not confirmed until last procedure is completed.

Small sponges peanuts etc should be attached to an instrument when use din a cavity

Nursing student shall be deemed supernumerary until competent

Heathcare assistants/support workers shall not be involved with the count until competent

Swabs or packs shall be packaged in bundles of 5 and be of uniform size & weight

Use of pre-printed whiteboard as counting aid