What risk management practices might prevent this scenario from happening on another occasion?
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:
Appropriate responses include:
Follow policy relating to the count as this is a risk management practice.
If the count is interrupted, recommence the count.
Be clear when communicating the outcome of each surgical count to the surgeon.
Ensure that the surgeon provides an audible response to acknowledge the outcome of each surgical count.
Monitor and confirm the location of accountable items throughout the procedure, rather than waiting for the count.
Audibly announce the placement of accountable items inside the wound and ask the circulating nurse to record details and time on a whiteboard (or similar method).
Ensure that such records reflect clinical changes such as the removal of sponges.
Call for supervisors if the surgeon is non-compliant with policy.
Practise converting from closed to open surgery (during downtime in an empty OR) so that you are more familiar with requirements (equipment, drapes, table space etc).
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