28 - Safeguarding the Surgical Count Process

Description: Description of Team
The Nursing Leadership Triad consists of the Clinical Nurse Specialist, an advanced-practice registered nurse trained to implement evidence-based strategies to enhance nursing practice, improve patient outcomes, and achieve institutional goals, the Nursing Professional Development Specialist, who plans, develops, coordinates, delivers, and evaluates nursing staff development programs and just in time education, and the Nurse Leader, who oversees the administrative and clinical operations at the point of care.

Preparation and planning
At a Magnet ® and NCI-designated Cancer Center, the surgical count policy outlines a high-reliability process of counting surgical instruments and supplies to establish a baseline and prevent retained surgical items (RSIs). One aspect of this process is to obtain an X-ray to rule out an RSI in the event of count discrepancies. In 2024, over 160 incidences of surgical count discrepancies with rule-out RSI X-rays occurred in the Main Operating Room. This led to unnecessary radiation exposure to our oncology patient population and increased the cost of care to resolve the discrepancies.
The goal of this initiative is to reduce the number of rule-out RSI x-rays by 25% by December 31, 2025, using the following strategies:
1. Observe baseline surgical counts to determine factors affecting the integrity of the count
2. Review literature on factors impacting the surgical count process and interventions to prevent discrepancies
3. Develop strategies to reduce surgical count discrepancies and unnecessary rule-out RSI x-rays
4. Evaluate the success of the initiative using outcome metrics

Assessment
Observations of the count process reveal factors impacting the integrity of the baseline surgical count include:
1. Distractions during surgical counts
2. # Instruments trays counted
3. Utilization of instrument inventory lists
4. Preparedness of the nursing teams

Implementation
The interventions for this initiative include:
1. Update and integrate surgical preference cards into the new electronic health record
2. Staff education on the factors that affect the integrity of baseline surgical counts
3. Establish a "No Distractions Zone" during baseline surgical counts
4. Conduct staff surgical count knowledge assessment surveys two weeks before and three months after implementation

Outcome
The pre- and post-implementation outcomes metrics include:
1. Staff Knowledge Assessment Surveys
2. # Surgical Count Discrepancies
3. # Rule-out RSI X-rays
4. Cost of Rule-out RSI x-rays
5. Surgical time

Implications for perioperative nursing
Discrepancies in surgical counts lead to unnecessary radiation exposure to patients, increased time spent in the operating room to resolve these discrepancies, and increased cost of care. By establishing a "No Distractions Zone" during baseline surgical counts, perioperative leaders provide nursing staff the tools to prevent surgical count discrepancies, improve the quality of patient care, and reduce hospital costs.