Grocery store technology finds place in OR
Grocery store technology finds place in OR
Bar coding offers tool for counting sponges
Every year in the United States, about 1,500 people have surgical items accidentally left inside them following a surgical procedure.1 About two-thirds of these items are sponges, which can lead to pain, infection, difficulty healing, and additional surgeries.
One new tool that can help outpatient surgery programs ensure accurate counts before and after surgery are bar-coded sponges.
"We had some concerns about using bar-coded sponges because it is new technology," admits Jo Quetsch, RN, clinical director of surgical services at Loyola University Medical Center in Maywood, IL. "The new sponge is the same brand and type of sponge we've been using, but it has a unique identifier attached to it."
The concern was that the identifying bar code would come off or be obscured once it was soaked with blood, Quetsch explains. "Our concerns were unfounded, and we've not had a problem with the system," she adds.
The bar-coded sponge used at Loyola is manufactured by SurgiCount Medical in Temecula, CA, but there are others on the market, Quetsch says. "We chose the SurgiCount system because it relies upon the use of a handheld scanner, which we found to be more reliable than a wand," she says.
For Loyola, the additional cost of sponges for all 19 operating rooms of the surgery department, which handles outpatient and inpatient procedures, is about $70,000 per year, says Quetsch. "For our department, this is an insignificant cost, especially when you consider the potential costs caused by a retained sponge," she points out.
There was a one-hour training session for all operating room staff members, says Quetsch, "but I do wish we had scheduled more hands-on training before going live." After extensive education about improving the counting procedure to enhance patient safety efforts, staff members understood the reason for a switch to bar-coded sponges, but using them does add time, and you do have to hold the scanner correctly to read the bar code, she says.
"Although our surgeons also understood the importance of our efforts, we did have some surgeons concerned about the extra time needed to scan the sponges," Quetsch admits. At first, scanning the sponges added an extra 15-20 minutes to operating room time, but three months later, extra time is down to 10 minutes, she says.
At this time, the bar-coded sponge is the only new technology used in the surgery department's efforts to eliminate retained objects, but there are other developments that the staff are watching, says Quetsch. "There are companies that offer bar code technology on instruments as well," she says.
Have clear policies
Using new technology only is one part of Loyola's efforts to reduce the risk of retained objects, points out Quetsch.
"We are into our second year of a project to revamp our count procedures and enhance patient safety in the operating room," she says.
In addition to implementing the bar-coded sponges, a new 20-page department policy that describes counting procedures for all surgical items including sponges, needles, and instruments, Quetsch says. It applies to everyone in the surgical department, not just nurses, she points out. "It's important that all members of the surgical team, including the physicians, understand the correct process because we work together to ensure the safety of the patient," Quetsch says.
Even though the Loyola staff use the bar-coded sponges, the procedure calls for a manual count, backed up with the bar-coded information, says Quetsch. "We count and scan before and during the procedure as sponges are used, then again as sponges are removed," she says. The addition of the bar code scanning ensures that sponges are not double-counted, Quetsch says. "It's very easy to get distracted during a manual count and count one sponge twice, but this technology doesn't allow it to happen," she says.
At the University of Minnesota Medical Center in Minneapolis, Carol Hamlin, RN, MSN, director of departmental performance for perioperative services, says, "We haven't gone the route of bar-coded sponges because the technology is so new and we want to wait for it to be tested more."
Even without technological assistance such as the bar-coded sponge, the number of retained objects in the Minnesota surgery department has been zero for over three years, following an extensive study of factors contributing to retained objects and development of clear, well-defined procedures for counting and looking for missing objects, she says. After nine occurrences of retained objects in an 18-month period, the surgery department conducted a failure mode and effects analysis.
"We had investigated reasons for each occurrence, but they kept happening, so we looked at the entire process, including any related human factors," Hamlin explains. "We found many issues that contributed to the risk of miscounting objects." The issues fell into three main categories: the method used to count objects, the environment, and the count policy.
"There was no consistency in the way that people counted," Hamlin says. "Some people documented with hash marks, others used numbers, some began the count on the back table then moved into the field, and others started the count at the field and then moved out to the back table."
When the difference in counting is added to distractions in the environment and the possibility that another person has to take over the counting, it is difficult to be accurate, says Hamlin. "Our staff members reported that they often felt hurried or harassed if they had to recount," she says. Operating room staff members also may be asked to stop what they are doing to answer a physician's page or get a replacement instrument for one that is dropped, she says. "Timing of these requests is important because if they occur during a count, it can cause a mistake."
The count policy was poorly written, admits Hamlin. "Every time we had an incident, we would revise part of the policy," she says. The constant revisions and the piecemeal approach to rewriting the policy enhanced the opportunity for misunderstanding, she says. "It was as difficult as reading an instruction manual for a new remote control or a cell phone," she says. The frequent revisions also meant that staff members did not have enough time to fully understand and master new procedures, she adds.
Changes in the policy addressed the policy content itself, behavior in the operating room during the counting process, and actions to take if the count is off at the end of the procedure, says Hamlin. [For specific changes, see box. A copy of the count policy is available.]
Developing a count policy, and finding the tools and approaches to reduce the risk of obtained objects, requires careful planning and evaluation of the entire process, says Hamlin. "The devil is in the details," she says. "Make sure everyone knows what to do and why they are doing it."
Reference
- Gawande AA, Studdert DM, Oray EJ, et al. Risk factors for retained instruments and sponges after surgery. N Engl J Med 2003; 348:229-235.
Sources/Resources
For more information about reducing the risk of retained objects, contact:
- Carol Hamlin, RN, MSN, Director of Departmental Performance for Perioperative Services, University of Minnesota Medical Center, Minneapolis. Telephone: (612) 273-6667. E-mail: [email protected].
- Jo Quetsch, RN, Clinical Director of Surgical Services, Loyola University Medical Center, Maywood, IL. Telephone: (708) 216-9650. Fax: (708) 216-0478. E-mail: [email protected].
The following companies offer products designed to improve the accuracy of counts in the operating room:
- SurgiCount Medical, 27555 Ynez Road, Suite 330, Temecula, CA 92591. Telephone: (951) 587-6201. Fax: (951) 587-6237. Web: www.surgicountmedical.com. Produces bar-coded sponge system.
- ClearCount Medical Solutions, Pittsburgh. Telephone: (412) 931-7233. Web: www.clearcount.com. Produces bar-coded sponge system.
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