Langley and Warren vs Glandore: Implications of Retained Surgical Instruments

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Langley and Warren vs Glandore
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Langley and Warren Vs Glandore Case
The case of Langley and Warren Vs Glandore was characterized by negligence
and lacked accountability, problems that may be affecting the perioperative practitioners
on a daily basis. From the investigation that was conducted, the jury found out that the
two surgeons, Langley and Warren were liable for leaving surgical equipment in the
abdomen of Glandore during a surgical procedure, an act which is termed as
negligence. However, the court ruled in favour of the two surgeons holding that there
are certain procedures within the perioperative environment that is not under the control
of the surgeons. Instead, the court found the perioperative nurses guilty of acting
negligently by failing to verify the number of sponges at the end of the surgical process.
According to Jones (2010), accidents and injuries within the healthcare facilities are
happen in the perioperative environment more than any other location. It is therefore
important for healthcare practitioners to collaborate to ensure that accidents such as
retained items are avoided by all means possible. The role of perioperative practitioners
is to promote standards for safe perioperative practise by optimizing positive patient
experience throughout the surgical pathway within the perioperative environment. It is
therefore a frightening experience for any nurse within the perioperative environment to
commit errors that can be easily prevented by following the guidelines set by the health
facilities as well as principles of practising in a perioperative environment as per the
Australian College of Operating Room Nurses (ACORN standard ‘Management of
accountable items used during surgery and procedures’ (2018). Cases like the Langley
and Warren Vs Glandore have the abilities to enable healthcare facilities reconsider
their policies and standards in perioperative environment since some perioperative
practitioners have the ability to mobilise ideologies from a different era in order to stake
a claim to authority and leadership on the grounds of their legal accountability for the
care of a patient. However, it is important to look at the factors that contribute to such
incidences and how the emergence of new technologies can be used to prevent
occurrences like retained surgical items in future.
Evidence-Based Conclusions About the Implications of Retained Surgical
Instruments

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In every perioperative setting, surgical count is a very crucial procedure for
ensuring patient safety. Surgical count is the process of counting any item that may
however remote be retained in a patient during a surgical procedure (Freitas, Mendes
and Galvão 2016). National standards for counting accountable items which are at risk
of being retained in the patient and which requires mandatory documentation should be
employed in any preoperative setting. Preoperative environment involves critical
procedures that requires confidence and competence of the preoperative practitioners.
That is the reason as to why there must be a collaboration to avoid surgical
discrepancies. According to ACORN (2018), surgical count must be performed by two
nurses, one of whom must be a registered nurse and an assistant nurse. During
surgical procedures, the two nurses retain responsibility for all the surgical counts.
Despite the implementation of surgical counting manuals, retention of items in patients
during surgery is still persistent. A study conducted by Greenberg, Regenbogen, Lipsitz,
Diaz-Flores and Gawande (2008) show that at least one in eight surgical procedures
involves an intraoperative discrepancy in the count which takes 13 minutes to solve.
After the preoperative practitioners’ changes, counting activities are highly likely to
involve discrepancies. However, the rate of occurrence varies according to the past
studies. A study conducted by Cima et al (2008) found out that retained surgical item
occur in one of every 5,500 operations and sponges account for 48% to 69% of the
retained items with the abdomen being the most involved cavity. In the case of Langley
and Warren Vs Glandore, the discrepancy involved may have been unnoticed thus
causing the unintentional retention of the sponge in the patient’s abdomen. With the
high cases of retained items, hospitals need more reliable practises to help prevent
retained surgical items as they lead to numerous consequences. Although the retained
surgical items are rare medical errors as per the previous conducted researches, they
have the potential to cause significant harm to the patient as well as carry profound
professional and medicolegal consequences to the physicians and the health facilities.
Of the notable consequences of retained surgical items are reoperation which is 69%,
readmission or prolonged stay in the hospital which is at the rate of 43%, 43% sepsis or
infection, 15% fistula or bowel obstruction, 7% visceral perforation and 2% cases of
death as per the study conducted by Gawande, Studdert, Orav, Brennan and Zinner,

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(2003). Besides the outcomes, retained surgical items can also lead to numerous
financial and reputational consequences for the hospitals. Events of retained surgical
items as well as the strategies to prevent them increase the cost of healthcare delivery.
Costs associated with retained surgical items include loss of the reimbursements for the
procedure itself, high cost of care to those associated with additional hospitalization or
readmission to manage the problem, malpractice settlements, and litigation. Patients
who have suffered events of retained surgical items may also be exposed to risk factors
that may increase their likelihood of suffering further injuries or diseases. These include
higher body mass index, emergency surgical procedures, incorrect surgical counts
reported as well as unplanned change or event in operation (Hariharan and Lobo 2013).
However, it is important to note that the manifestation of these retained items is different
depending on their location and type of item and tissue elicited. While others may
remain intact, others can move thus causing tumours or even excessive bleeding.
Factors Contributing to retained surgical items
The causes of safety events are usually related to errors in practise or lack of
effective communication. According to Freitas, Mendes and Galvão (2016), retained
surgical item cases as a result of unreliable preoperative environment practises.
Flattening hierarchy as well as personal decisions are drivers of unethical practises. It is
therefore important for preoperative practitioners to follow the ethics and codes of
practise since they will always be held accountable for their actions. Poor
communication in the preoperative environment leads to an unsafe culture which affects
the safety of the patient, engagement of the professionals, decision making, morale and
even retention. Communication delays can also lead to delayed procedures,
inconveniencing of the patients, as well as retention errors. Chaos and distractions can
also lead to retained surgical items (Zejnullahu, Bicaj, Zejnullahu, and Hamza 2017).
This is because of performing different things at a go or even unforeseen procedural
changes. Distractions may be in form of people entering and exiting the preoperative
setting, telephone calls and beeps, alarms, and since surgical procedures requires high
cognitive demands, it needs undivided attention. Some human factors that cannot be
controlled like distraction and exhaustion are also contributing factors to retained