Identify at least four risk factors throughout the procedure that may have contributed to an incorrect count

Question

You are waiting for a patient booked for a routine laparoscopic cholecystectomy late in the afternoon. As you commence your surgical count with the circulating nurse, the surgeon arrives and tells you about his requirements. After this interruption, you complete the count and the surgery commences. Subsequently, in response to uncontrolled bleeding, the surgeon converts to an open procedure. Your circulating nurse has opened additional instruments and accountable items and you remain focused for some time on the surgical count and check of instruments. After 3 hours of surgery, the closure commences and you discover a discrepancy in the count.

What will be an ideal response?

Answer 1

Answer:
Appropriate responses include:

Length of procedure
Fatigued staff
Emergency situation with increased and unexpected blood loss
Competing demands, rushing and performing multiple tasks
Converting from closed to open surgery with extra accountable items being added mid-procedure
Poor communication between surgeon and nurses

You inform the surgeon that there is a discrepancy in the count but he continues to close the wound. The surgeon is confident that the missing sponges are not in the wound and suggests that you have miscounted. The floor coordinator becomes involved and informs the surgeon that he must check the wound for the missing sponges, otherwise the patient must be x-rayed prior to leaving the OR to ensure that the missing sponges are not in the wound. The surgeon is very annoyed but agrees to recheck. At this point he finds the missing sponges under the liver.