Preventing Retained Surgical Objects : Using Best Practices , Adjunct Technology
By Kelly M . Pyrek
Unintentionally retained surgical items ( RSIs ) in patients undergoing operative and other invasive procedures represent a significant infection and mortality risk . The Association of perOperative Registered Nurses ( AORN ) has recently strengthened its position on this adverse event by providing updated guidance on implementing a consistent interdisciplinary approach and using standardized procedures to prevent RSIs , accounting for surgical items , preventing retention of device fragments , and reconciling count discrepancies . Guidance is also provided for use of adjunct technology during manual counting procedures .
As the AORN guidance explains , “ Perioperative team members are ethically and morally obligated to protect patients by implementing measures to prevent
The true RSIs .” This creed is registering with perioperative personnel ; in a survey conducted incidence of by Steelman et al . that included 3,137
RSIs remains responses from perioperative registered unknown in nurses ( RNs ), 61 percent of participants identified the prevention of RSIs as one part because of the top priorities for perioperative
retained patient safety . RSIs continue to be one of the most items may be common sentinel events reported to The undetected Joint Commission , but experts express concern that these events are likely for months or underreported and underestimated . AORN years .” explains this might be due in part to the lack of a universal definition of RSI and varying reporting requirements . As AORN points out , “ The true incidence of RSIs remains unknown in part because retained items may be undetected for months or years .” AORN adds , “ Reported methods of RSI discovery include symptoms , radiological evaluation , and physical examination . Time to diagnosis of an RSI can vary greatly . Reports suggest that many RSIs are discovered between the time of occurrence and two months , some have been found between two months and five years and others have been found after five years .”
While surgical sponges are the most commonly retained items , AORN notes that “ as the rates of minimally invasive procedures and the use of adjunct technologies to prevent retained soft goods increases , there could be a shift in the number and types of items that are retained compared to soft goods . Other reported
RSIs are instruments , needles , device fragments , items such as guidewires , and miscellaneous items . Most counting discrepancies involve needles .”
Many states require public reporting when RSI events occur . Federal and state agencies , accrediting bodies , third-party payers , and professional associations consider an unintentionally retained foreign object to be a serious and largely , if not entirely , preventable event ( never event , healthcare-associated condition , sentinel event , serious reportable event ). Consequently , healthcare organizations and providers will not be reimbursed for additional care provided because of an RSI .
A long-standing and evidence-based strategy for preventing RSIs is to account for all items opened or used during the operative or other invasive procedure . Healthcare organizations are responsible for employing standardized , transparent , verifiable , reliable practices to account for all surgical items used during a procedure . Counting radiopaque soft goods , sharps , miscellaneous items , and instruments is one method to account for all items used on the surgical field . However , there is a significant potential for inaccurate counts with the use of manual counting practices . The use of adjunct technology can decrease counting discrepancies and has the potential to reduce the risk of RSIs , AORN says .
The biggest change to AORN ’ s Guideline for Preventing Unintentionally Retained Surgical Items for 2022 is the new recommendation for adjunct technology to account for soft goods .
“ Evidence on retained surgical soft goods suggests that the accuracy of manual counting is unlikely to dramatically improve without assistance ,” says Julie Cahn , DNP , RN , CNOR , RN-BC , ACNS-BC , CNS-CP , senior perioperative practice specialist at AORN , and author of the RSI guideline . She says some types of adjunct technology devices have been shown to reduce the rate of count discrepancies , decrease time reconciling count discrepancies related to soft goods , and decrease costs associated with count discrepancies , such as costs for radiological imaging .
Cahn stresses that adjunct technology should never replace manual counting because it remains an important step to account for surgical items used in the wound .
Other practice updates specific to preventing unintentional RSIs include a new section on preventing retained foam pieces from negative-pressure wound therapy devices , such as by cutting the foam only when necessary to fit in the wound and limiting the number of pieces of foam used when possible . New recommendations in the section on preventing retained
www . healthcarehygienemagazine . com • march 2022
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