Incorrect Surgical Counts Risk Factors

Incorrect surgical counts risk factors
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Sadaf Naveed

Introduction
‘Operating theatres are dynamic environments that require multiple professional team
interactions. Effective teamwork is essential for the efficient delivery of safe patient care'
(Wilson & Farooq 2018: 188). The perioperative practitioner/scrub nurse plays an important
role in maintaining a theatre environment safe for patients and work as a patient's advocate
(Nursing & Midwifery Council (NMC), 2015). One of the primary roles of the scrub nurse is
to ensure that surgical counts are done correctly and to protect patients from retention of
unintended surgical items (Association of Perioperative Registered Nurses (AORN), 2015).
The perioperative surgical counts are crucial and play an important part in promoting the
surgical patient’s safety. It is serious and classified as ‘never event’ when surgical items
remained in the wound unintentionally (Department of Health (DOH), 2013), considered an
unacceptable and preventable error with the requirement to report to The Joint Commission
as a sentinel event since 2013 (Hariharan and Lobo, 2013; Norton, 2014; Goldberg &
Feldman, 2012).
Objectives
The author of this essay is a qualified staff nurse who has worked in theatres for one year as a
scrub nurse. The scrub nurse will be reflecting upon her own experience. In this assignment,
the fundamental reasons (such as human factors) will be explored. The reason surgical counts
procedure and related protocols fail in practice will be discussed. Key findings around
national and local standards and policies will be critically discussed. The essay will analyze
risk factors and interprofessional issues related to the scrub nurse role associated with the
retained surgical items. The author will explore the implications of why surgical items counts
are not done properly and why best practice not been followed. Finally, an action plan will be
presented to improve perioperative practice by training staff and keeping them up to date with
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local and national guidelines related to surgical counts and to effectively implement best
practice.
Policies, Recommendations and best practice in relation to surgical counts
The World Health Organisation (WHO) (2008) started a campaign "Safe Surgery Saves
Lives" in this there were ten objectives and among these, there was an essential to ensure
surgical safety, by preventing retention of surgical items in surgical wounds. Surgical counts
are a manual process to count surgical items such as instruments, swabs, needles, etc used in
the sterile field during surgeries between two theatre personnel, one of whom must be
registered perioperative practitioner (Association for Perioperative Practice (AFP) (2011).
The WHO (2009) recommends, as a guideline for patients’ safety, the undertaking of the
counting process in every surgery and indicates the need for counting all surgical items used
in the sterile field. Instruments must be standardized and listed. It should be in the operating
department policy to specify all surgical items should be counted and recorded during the
counting procedure (AFPP, 2007). To maintain patient safety and prevent the risk of
accidental retention of surgical items the scrub nurse must count all the recordable items for
both major and minor cases. The scrub nurse follows the policy for when the counts should
take place; such as all surgical recordable items must be counted before the start of surgical
procedure, when scrub nurse receive any extra items during the procedure, at the closure of
body cavity such as sternum closure during cardiac surgery, at the start of wound closure,
every skin layer closure and following completion of the procedure. It is a scrub practitioner's
professional responsibility to adhere to policy (AORN, 2013).
The instrument count is recorded by the circulatory practitioner on the tray sheets provided
by the sterilization department within the packs. Swabs, needles, and sharps, etc are recorded
on the whiteboard by circulatory practitioners which is visible to scrub nurse (Goodman and
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Spry, 2014). All the whiteboard items are also documented on theatre care plan which stays
in patient's notes. For instruments which come in several parts, it is the scrub nurse’s
responsibility to check that all instruments are complete, there is no part is missing and it is in
working condition before use (Wicker and Dalby, 2016). It is the duty of scrub to count aloud
and record all surgical items together with the circulatory practitioner (AORN, 2013). If
during or at the end of the procedure the counts are incorrect, it is scrub nurse responsibility
is to inform the surgeon immediately (AFPP, 2011., Wicker and O’Neil, 2010).
It is important that staff follow the National Safety Standards for Invasive Procedures (Nat
SSIPs) (2015) or Local standards for invasive procedures (LocSSIPs). The NatSSIPs (2015)
was authorized by NHS England. The aim of this document is to promote patient safety by
reducing the number of safety incidents for the patient undergoing invasive procedures and to
prevent ‘Never Events’. NatSSIPs (2015), using existing frameworks such as WHO checklist,
teamwork, and human factors produce its principles for healthcare professionals to implement
best practice and deliver safe patient care. This includes standardized WHO safety checklist,
which is designed to improve communication and teamwork between theatres surgical team.
It also promotes staff education and training. To recognize human factors and prevent Never
Events occurring.
NMC (2015) and Health and Care Professions Council (HCPC) (2016), state that the
registered practitioners are accountable for their own conduct, their actions, and omissions in
practice. The scrub nurse must have knowledge and understanding, and this includes legal
knowledge and must be aware of the limits that the law imposes on her or the power it gives
her, been unaware or ignoring the law can’t defend the practitioners (Dimond, 2015).
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Sadaf Naveed