248 - Mastering Counting Basics in Surgery: A SMART Card Approach

Description: Surgical count accuracy is essential in preventing unintentionally retained surgical items. The ability to standardize the count process goes beyond having a policy. Having perioperative staff who can be either employed or contracted increases the risk of practice drift due to staff's misconceptions of what should be counted and when. In a 9-hospital system, the complexity of aligning policy on counting practices is compounded.
Variation in counting practices increases risk for error in surgery. According to AORN, use of a consistent, standardized practice has been shown to reduce the reports of incorrect counts and rates of overall serious reportable events. The Smart Card tool is a concise resource that staff can use when questions arise on what items should be counted, how to count, or what to do if a miscount occurs and eliminate variable counting practices. Smart Cards are tools that provide real-time insight into key quality, safety, and accreditation risk points, and lead to meaningful conversation with immediate feedback to improve patient care. The cards were hung in each operating room and reviewed monthly at shift huddles.
Since implementation, there have been no unintentionally retained foreign objects reported and staff understand policy expectations when counting. It gives them a reference to policy close at hand when medical staff are questioning reconciliation of counts. Clear, concise reconciliation decreases OR time for the patient. The Smart Cards offer staff easily accessible information that is non-punitive and non-judgmental. Creating targeted content which mirror policy and best evidence in an easily digestible format has been mutually beneficial to nursing and medical staff.
With the success of the Counting Basics Smart Card, other cards have been developed and implemented such as Abdominal SSI Prevention Bundle and Surgical Fire Safety. The Smart Card inventory puts clarification of policy or practice change directly in the hands of staff promoting active engagement.