Monday, October 20, 2008

Sponge Count

 Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active and it was easier than checking each one.

It’s one of those things you do (or rather the OR staff does) at the end of a case.  I usually continue to sew the last layer of skin as the count occurs.  If there is ever a question, then I may help locate a “missing” sponge or lap.  Usually (in my cases) they are just bunched together or one got tucked into the drapes.  That will mean that the first “final” count was wrong, but the second “final” count correct. 
Apparently, according to a recent article in the Annuals of Surgery that was quoted in the AMA News: 
While cases of retained foreign objects are rare -- occurring once in every 5,000 surgeries -- discrepancies in counts happen in 13% of surgeries, according to an August Annals of Surgery study.
I can honestly say, all the counts on all the surgeries I have ever done  have been correct.  No sponges, laps, needles, or instruments have been lost.  My cases now are more organized than some of the major trauma cases I was involved in during my training.  I can see how the counts were sometimes off.  When you have what amounts to 2-3 different surgery teams (neuro, ortho, and gen surgery) all working on a single patient at the same time, it can get chaotic.  In times like that, you sometimes wonder if the initial count was correct.  In other words, sponges, laps, needles, etc don’t have to be lost for the final count (end of case) not to match the initial count (beginning of case).
My fear of loosing a sponge in a breast case means I don’t use them.   If they come in the pack, I ask the scrub tech to put them on the back field to be used as part of the dressing.  Years ago, I finally managed to make the “the powers that be” see that if the count was correct, then it was wasteful to not use the clean sponges as part of the dressing.  If an x-ray did need to be done for any reason in the recovery, I would happily just change the tagged sponges out for them.  Hasn’t happened (knock on wood).
I use lap sponges (see above photo) with the blue tags.  This tag helps keep them from being lost.

There is a push to get hospitals and surgery centers to buy gadgets (photo credit) like the SurgiCount's Safety-Sponge™ System featured recently over at Medgadget.  The surgical sponges are individually bar-coded and then counted with the portable scanner.  This would work nicely on scheduled cases, but I wonder how well it would work on those trauma cases when the sponges are needed three minutes ago.  Would be interesting to see it in action on those cases.

 SurgiCount Medical website

Sponges, surgical instruments miscounted in 13% of surgeries:  Getting the count right in the operating room is a challenge. New technologies could make things easier.  By Kevin B. O'Reilly, AMNews, Sept. 22/29, 2008.
"The Frequency and Significance of Discrepancies in the Surgical Count," abstract, Annals of Surgery, 248(2):337-341 August 2008; Greenberg, Caprice C MD, Regenbogen, Scott E MD, Lipsitz, Stuart R ScD, Diaz-Flores, Rafael MD, Gawande, Atul A MD
NoThing Left Behind: A Surgical Safety Project to Prevent Retained Surgical Items


Øystein said...

I heard a story once about a senior surgeon at my hospital who used to let a sponge fall to the floor during the operation, and hide it under his shoe, to check if the nurses counted right.

Dragonfly said...

I once saw an open abdominal case delayed by 40 minutes because of a lost sponge. By the end the surgeon was pulling intestines out of the incision like a magician pulls streamers out of a hat.

I have never felt so sorry for anyone as for the nursing student on her first day who hadn't had counts explained to her properly yet and had thrown it in the bin.

Medical Quack said...

Great article and I added some information I had from prior posts on sponges as well. Here's another line from Reuters too. Thanks Ramona for the great input!