Mrs Tagaloa is at potential risk for unintentionally retained surgical items. What factors contribute to her being at additional risk, and what can be done to prevent harm?

Question

Mrs Lanuola Tagaloa is a 54-year-old Samoan woman who has lived in Australia for the past 15 years. She was admitted on the day of surgery for an elective vaginal hysterectomy with anterior/posterior colporrhaphy. She has a history of asthma and has type 2 diabetes mellitus (diagnosed at 42 years of age). Mrs Tagaloa has a history of grand multipara. She has a BMI of 30+ and falls into the obese category, but appears otherwise fit and well. She lives at home with her extended family and is responsible for the care of her mother and school-aged children. The admissions nurse informs you that Mrs Tagaloa is very softly spoken and did not maintain eye contact. She was accompanied by a female family member and overheard to be conversing in her native language.

What will be an ideal response?

Answer 1

Answer:
Mrs Tagaloa is at additional risk for the following reasons:
obesity
increased risk of bleeding due to well-vascularised surgical tissue
small surgical field with limited visualisation
complexities of operative procedure (three stages of operation: hysterectomy, anterior vaginal wall repair, posterior vaginal wall repair).
Vigilance is required throughout the counting procedure, along with careful and systematic management of accountable items within the sterile field.
The number of staff involved in the count procedure should be the minimal required.
Clear communication between all team members as to the location of accountable items throughout the procedure is crucial (e.g. ‘raytec in the vagina', ‘raytec removed from the vagina').
According to the ACORN Standard ‘Management of accountable items used during surgery/procedures in the perioperative environment' (2016), a minimum of two counts is required; however, where a body cavity is entered, an additional count is undertaken when the body cavity is closed. The abdominal cavity is opened and closed three times in Mrs Tagaloa's surgery: during the vaginal hysterectomy, the anterior vaginal repair and the posterior vaginal repair. A count of all items should be conducted and recorded every time the abdominal cavity (peritoneal layer) is closed.
Clear and accurate documentation should be maintained, with confirmation between the circulating and instrument nurses whenever an accountable item is added to the count.
Clear verbal communication with the surgeon is necessary, to confirm the accuracy of each closure count.