136 - Count Boards Improve Communication, Enhance OR Safety

Description: The team included every member of the operating room: circulating RNs. RN First Assists, Physician Assistants and Surgical Technologists (ST). The RN and the ST are equal partners in the count. Their communication is a key element to making the count process correct. The Surgical Technologist's role is unique in that they can see and keep track of all the surgical items used but cannot see the paperwork. The Circulator's role in the count is limited by their ability to directly visualize the surgical field for the entirety of the case. Using the count board allows both parties to visualize the correct number at any time. RNFA's and PA have the upfront role of assisting and can keep track of the whereabouts of all surgical items throughout the case and communicate that to the RN and ST.

Preparation and planning. The purpose of the team was to prevent retained surgical items. When counting at the end of surgery, the surgical team suffers many interruptions. In hopes of improving communication among the OR team, a discussion ensued. The concept of a board that everyone could always see would make communication faster and more accurate. The board concept was endorsed by the manager and presented to all the stakeholders involved as both brainstorming and buy-in.

The unit practice council conducted a literature search and queried their local AORN chapter by posing questions for potential strategies from their certified peers. The Middlesex AORN chapter 3107 gave great feedback on different board designs and some implementation pitfalls to avoid. We used the AORN tools such as the Retained Surgical Items Decision Tree, Count Board Examples, articles like the December 2020 AORN Journal article on preventing retained surgical items and the RSI AORN guidelines.

The group researched such options, ordered a count board to trial with the staff. A life-sized mockup of a count board was created and displayed in the lounge for all to peruse and offer comments and suggestions. The result was a collegial approach to the development of the count board, adding comprehensive ideas and dimensions to the count process.

Assessment. Prior to implementing the count board, we took a survey of everyone in the operating room regarding safety of the surgical count and communication. We asked questions about staff members' assessment of safety and their comfort while performing the count. Once we implemented the count boards, we repeated the survey one week after implementation, then again for two months and six months. These were compiled into a graph and presented to the staff.

Implementation. The OR team agreed that adding the count boards would enhance safety. Education on the practice of change was performed using a multifactorial platform. We had printed instructions, visual aids in common areas, lectures, and hands-on training. We incorporated the entire department into this training. Count boards were placed, and the new practice began. The OR staff were surveyed regarding the level of comfort and safety in the count process. The survey further supported our shared decision-making process impacting this new change in nursing practice. Based on feedback from necessary elements.

Outcome. Since the implementation of the count boards and the change in policy, there are no retained surgical items. and staff satisfaction has been extremely favorable. The collaborative nature of this project has the staff discuss other ways to improve safety and workflow knowing that process will make positive change by working together.