Improving system reliability to enhance the performance of human factors ( such as compliance with policies and procedures , effective hand-over communication ) may reduce the incidence of errors and improve patient safety .”
— Julie Cahn , DNP , RN , CNOR , RN-BC , ACNS-BC , CNS-CP
fragments during intravascular device use , such as guidewire fragments , provides new practices for instrument inspection before and immediately after use at the point of care .
Beyond the process of counting , systems and human factors play a significant role in contributing to RSIs . Therefore , behavioral changes and education about risk-reduction strategies unique to each setting used during the adoption of systems may improve accounting for surgical items . Improving system reliability to enhance the performance of human factors ( such as compliance with policies and procedures , effective hand-over communication ) may reduce the incidence of errors and improve patient safety .
“ There are known risk factors for RSI but they are not modifiable ,” says Cahn . “ This means we have little control to change them . There are also many contributing factors for RSIs and they are almost all modifiable . The three main categories of contributing factors identified by Steelman , et al . in three recent studies of retained items reported to The Joint Commission between 2012 and 2018 were problems related to human factors , ineffective leadership , and communication breakdown . When these risk factors occur , they could increase the likelihood of contributing factors to occur as well . For instance , RSIs may occur more frequently during stressful situations such as when an unexpected change in the procedure occurs , not because of the situation itself but because of the impact these conditions have on communication and human factors ( e . g ., teamwork , mindfulness ). Therefore , interdisciplinary interventions that focus on improving the system culture and human factors may help decrease the risk of RSIs . Focusing on modifiable interventions that target improvement of human factors or the system culture to prevent RSIs is important because many of the risk factors identified by early research were not modifiable . However , there is little research on the impact of human factors on RSIs .”
To help address human factors-related challenges , AORN recommends a systems approach to preventing RSIs that includes using standardized counting and reconciliation procedures , methodical wound exploration , radiological confirmation , adjunct technology , team training , and enhanced communication to promote optimal perioperative patient outcomes .
The AORN recommendation of using adjunct technology has existed since 2016 , Cahn explains , noting that , “ This year we strengthened the recommendation because it is clear that manual counting procedures will not improve in accuracy by themselves . Additionally , research is available to show that use of adjunct technology for the prevention of surgical soft goods will decrease the rates of count discrepancies , time spent reconciling count discrepancies , and use of radiologic imaging . All these things will reduce time , money , and potentially reduce the risk of an RSI . Therefore , with the backing of evidence , a strengthening of the recommendation to use adjunct technology for the prevention of
retained soft goods , may improve patient safety which is part of the mission of AORN .”
Adjunct Technology
AORN ’ s Guideline for Preventing Unintentionally Retained Surgical Items recommends the following :
• Use adjunct technology devices for the prevention of RSIs that are FDA-cleared or deemed exempt from premarket notification .
• An interdisciplinary team should evaluate adjunct technologies before implementation in the healthcare organization .
• Use an adjunct technology device to detect the location of surgical soft goods or to verify the outcome of manual counting procedures for surgical soft goods , when possible .
• The interdisciplinary team may evaluate RFID FDAcleared adjunct technology for detecting retained surgical instruments as a supplement to manual count procedures . ( This is a conditional recommendation .)
Source : AORN
Regarding the evaluation of adjunct technology devices , AORN recommends that “ Perioperative RNs , surgical technologists , physicians , infection preventionists , material management personnel , quality and risk managers , radiology personnel , sterile processing personnel , and other healthcare personnel involved in the use of the products and medical devices for prevention of RSIs should be part of the interdisciplinary product evaluation and selection committee when the healthcare organization is evaluating the purchase of adjunct technology . The interdisciplinary team composition may differ depending on the device being evaluated . For instance , if the device selected for evaluation includes specialized instruments with radio-frequency identification ( RFID ) tags , then sterile processing personnel may provide important insights on the cleaning , disinfection , and sterilization processes .”
AORN outlines an interdisciplinary approach as comprising the following steps :
• Use a consistent interdisciplinary approach for preventing RSIs during all surgical and invasive procedures .
• Implement measures for all perioperative team members to improve teamwork and communication as part of a collaborative interdisciplinary approach to RSI prevention .
• Actively participate in team training as a measure to prevent RSIs .
• Minimize distractions , noise , and unnecessary interruptions during the surgical count .
AORN also recommends that facilities “ Evaluate the manufacturer ’ s instructions for feasibility in practice ; process for cleaning , disinfection , and sterilization of reusable devices ( such as instrument tags ); process for cleaning and disinfection of equipment ; preferences of perioperative personnel ; associated costs ; radio-frequency ( RF ) interference with temporary pacemakers when applicable ; and RFID interference with pacemakers , implantable cardioverter defibrillators , and other electronic medical devices .”
Cahn points to the guideline ’ s synthesized account of the identified evidence on all the available adjunct technology devices on the market . “ This was included to help perioperative teams evaluating these products understand the evidence available