Should Surgical Counts Be Used in the Operating Room or Not - Personal Statement Example

? Surgical Counts Surgical counts account for all items that come into the operating room with the sole purpose of facilitating a surgical process. These include: sponges, sharps and other instruments. It is especially valuable in ensuring the safety of the patient during a surgical operation. This arises from the fact that even the most revered surgeons are not error-proof. In most cases, the aim of surgery is to repair and, whenever possible, to remove a diseased or malignant growth within the body. Accidental introduction of foreign bodies into surgical patients renders the whole process futile. Research shows that erroneous introduction of foreign bodies such as surgical sponges and towels after a surgical procedure is most prevalent (Lennon, 2011, p. 238). In keen hands, these could be instruments that save the lives of the patient, but a slight mistake could cost the same patient his or her life. Surgical count, therefore, helps in eliminating the possibility of worsening the patient’s condition through such errors, so the importance of surgical counts cannot be overestimated. The count on sharp items is, by far, the most important. This is true since the effect of such an instrument as surgical forceps within the body is, by all standards, fatal. This does not mean that the count of items such as sponges is not relevant. In essence, this only serves to bring out its relevance. Such were the ideas of reputable elites who conventionally generated the guidelines that govern the surgical count throughout the operative procedure. A subsequent declaration and appreciation as a practical regulation that bound the team involved in this process followed this development. This elicited an uproar by skeptical opinions, which portrayed this as an attack on the expertise of surgeons and the relevant persons that facilitate the surgery. It, however, is a matter of critical importance and should be looked at objectively. Risk Factors The numerous risk factors that may arise during the operative process make the surgical counts a necessity. The same risk factors cause an increase in the occurrence of inaccurate counts. In doing so, they also make the unintended introduction of foreign bodies into the patient a potential threat to the success of many surgical procedures. Such factors include emergency surgical procedures. It is common to skip surgical count prior to such procedure as it may be seen as loss of valuable time. According to Rothrock (2010), other risk factors are: an unexpected change in the extent or scope of the surgical procedure, surgical procedures involving more than one surgical team, an extended duration of a procedure and unexpected blood transfusion during the surgical process (p. 28). She also elaborated that these serve as critical points when items within the operating room may change hands. Caution must be taken to ensure that counting is accurate, and the parties involved have to be sensitized concerning the same. Surgical counts must be used to eliminate uncertainties and ensure that the occurrence of retained items in surgery is not present (Plumridge, 2009, p. 186). Patient Complications Gossypibipoma refers to a surgical sponge or towel that remains in the body advertently following surgery. Prevalent complications follow the retention of foreign bodies, mainly in the surgeries done in the abdominal cavity. Some of the significant complications that arise after retention of foreign body in intra-abdominal surgery include perforation of the bowel, sepsis, obstruction, fistulae and other visceral perforations (Lennon, 2011, p. 240). This is especially disastrous if their discovery occurs late. These, in the past, served to necessitate the need for a comprehensive, accurate and relevant method of managing surgical instruments prior to, during and after the surgical procedures. Statistics The common phrase that figures do not lie has led to the approval of surgical counts as a necessary precautionary measure by the World Health Organization (WHO). This followed the study done between the years 2000 and 2004. The study monitored a number of surgeries, and the count discrepancies noted and documented as true positives, false positives, true negatives or false negatives. True positives indicated count discrepancies where the retained foreign bodies discovered where. False positives were those counts where the retained foreign bodies never surfaced, and no complications experienced within a year. In false negatives, retained items surfaced within a year while, in true negatives, there were no retained items and no complications within the same period. According to AORN (2006), this did not take into account the number of pieces of broken or fractured surgical equipment. These have, in the recent past, been shown to lead to a number of postsurgery deaths or subsequent surgical procedures on the same patients. The AORN (2006) concluded that a re-evaluation of the surgical counts took place after this discovery. This was with regard to their specificity and sensitivity. Essentially, this served to reassure the safety of patients by determining the diagnostic characteristic of the counting as a screening test for the prevention of occurrence of retained foreign bodies. This statistical data utilized the previously documented results above and came up with findings that are as below. Needles are, by far, the most commonly miscounted surgical items. The results had also demonstrated that a good number of the miscounts were due to lack of documentation. Emphasis has since been on the importance of documentation. The following graphical representation (AORN, 2006) depicts this grim revelation. Advantages Counting of sharps and miscellaneous items takes place before every surgical procedure. This eliminates the possibility of retained items. This takes into account that the surgical procedures are by nature invasive and every item taken into the operating room must be logged in a spreadsheet. This provides the patient with support in the perioperative setting. This acts as the first safety step in protecting the patient against subsequent subjection to surgery so as to remove the foreign body. According to Fuller (2010), each count takes place independently and at different stages so as to resolve any qualms that may have arisen from the initial count. This goes a long way to keep all items in check and diminish the chances of retaining the foreign bodies within the body of the patient. This is especially crucial when a surgical procedure involves more than one surgical team. Such surgical procedures take a long time, and the surgical team might get fatigued. It is during such points that surgical counts become most relevant. The proper steps may be followed to resolve any anomaly that may arise. A count of sponges, sharps and instruments must be entered in the patient's intraoperative record, and the same reflects in the patient’s chart (Rothrock, 2010, p. 29). This provides a chance for timely detection of retained items without waiting for the consequential signs such as hemorrhages. These proved fatal in the past. Lennon (2011) documented that a surgical count is wholesome and effective as it encompasses all the items used in the surgical procedure. He stated, “This rules out the possibility of overlooking certain items that might not be considered dangerous.” An excellent example is the tucked sponge. Guidelines govern the surgical counts and also provide the criteria that are to be followed in case of parallel procedures (AORN, 2006). This includes the provision of two or more circulars that aid in the counting process. It is now easier to account for all the surgical items through cross-referencing which is done by an independent party. This process of count is also favorable since the documentation is a standard procedure made so electronically or manually. This refers to the popular retained foreign object (RFO) count process. This allows for independent review of the counting process and also enhances the objectivity of the counting system. Fuller (2010) explained that surgical counts are also reliable because of the existence of standardized counting procedures that all surgeons, perioperative nurses or any other surgical technologist are familiar. These guidelines also help to ensure surgical teams adhere to protocol even during changeover in the cases that require multiple surgical teams. It also allows any surgical team to comprehend the possible need for additional instruments. Disadvantages Fuller (2010) stated, “Surgical counts tend to overlook the pieces of broken or fractured surgical instruments.” He went on to show that this creates an imminent risk as it jeopardizes the patient’s chances of survival. Such a shortcoming only shows the insufficiency of the surgical count process and not it being unnecessary. This, however, can be remedied by ensuring the counting process is inclusive of all items: from the smallest pieces of the instruments to the most noticed. This would serve to make it more reliable and efficient, which, in turn, translates to better health care for surgery patients. According to AORN (2006), multiple counts occur throughout the surgical process. Some surgeons consider this a distraction. Further, they do not appear in the spreadsheet, and this may increase the chances of having a discrepancy. This shows that as much as they are extremely crucial in the early detection of retained foreign bodies, they have to be done diligently. The sensitivity of the surgical counts also came under focus. This is because it totally relies on the technologist’s or perioperative nurse’s state of mind. This gives the person making the count the sole responsibility of ensuring accurate counts. This may be tedious and also inconclusive. Additional personnel should be involved, and they should work independently to ensure the count is accurate. Plumridge (2008) asserted, “When done inconclusively, counts can subject a patient to subsequent radiographic filming to help in locating the retained foreign body.” This is a health hazard, especially if the exposure to radiographic imaging takes place a number of times. Further, it is also evident that radiographic imaging is not effective in locating items such as sponges and towels. Such items, on a radiographic film, resemble the dense mass of body tissue, more prominently in the abdominal cavity. It takes more than the watchful eye of the average doctor to notice these items. This, in turn, leaves no option but to subject the patient to another invasive technique to help discover the positions of the sponges and towels. Conclusion Surgical counts go a long way in ensuring the safety of many postsurgery patients. When done diligently and in accordance with the guidelines recommended by the Association of periOperative Registered Nurses (AORN), they can be highly effective and help in minimizing the number of casualties that arise due to retention of foreign bodies within the bodies of patients during surgery. Surgical count, like any other system, has its own strengths and flaws. It is, therefore, of immense importance that we properly utilize these strengths. This would be particularly useful in improving the state of health care in the society today since the main idea is to preserve life. The flaws of the surgical count process suggest that more needs are to be met as opposed to doing away with this system. It rather calls for better methods of meeting them. This can easily be done taking into account the current technological advances that we have made in the health industry. A good example of such advances is the introduction of bar coded sponges which are available and are in use today. This is rather costly, yet effective. This calls for re-evaluation of the cost effectiveness and makes it more affordable for all hospitals. Another advancement made is the use of radiofrequency detection techniques in the count of sponges. This utilizes the proprietary radio frequency (RF) beacons. Such advances in technology shed light on a previously dark future as it brings hope of reliable surgical counts. This, in essence, makes the current surgical processes be satisfactory. The importance of surgical counts cannot be overrated. This is because they would provide assurance on the competence of hospitals. It would put the many families of the surgery patients who place unwavering faith in the health care system at peace. It also calls for the dedication of the surgical technologists and perioperative nurses as the absence of diligence in their work would render the commitment of the surgeon useless, especially where the incidences of the retained foreign bodies end in the deaths of patients. Surgical counts are necessary in the operating rooms as they might just be what determines whether the patient lives or dies. An improved surgical count system, however, would mean that the next time a loved one goes into that operating room, we are certain that the outcome, whether favorable or not, is not because of a flawed system since we are not in doubt of the competence of the surgical team. References Rothrock, J. C. (2010). Alexander’s care of the patient in surgery (14th edition).London: Mosby. Fuller, J. K. (2010). Surgical technology: Principles and practice (5th edition). Philadelphia: W.B. Saunders Co. Plumridge, J. (2008). The child first and always: Health professionals (surgical counts).Retrieved from http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/surgical-count. Association of periOperative Registered Nurses (AORN). (2006). Recommended practices for sharp and instrument counts AORN. AORN standards, recommended practices and guidelines. Denver: AORN. Lennon, T. (2011). Prevention of retained sponges and towels [Review of the article “Cardinal Health: Surgical Count” by P. N. Webster]. Health and Times, 24, 234–241. Read More