CMHS -Prevention of Retained Surgical Items

Dry erase board is cleared of previous case information.

Count is initiated in a timely manner: Prior to incision at start of case.

Count is initiated in a timely manner: when wound closure begins.

Count is initiated in a timely manner: when skin closure begins, prior to dressing or skin adhesive.

Instrument counts are completed as appropriate (with open abdominal or thoracic wounds). The final instrument count should not be considered complete until the instruments used in closing the wound (e.g. malleable, needle holders, scissors) are removed from the wound and returned to the scrub.

Items added to the sterile field are noted on the dry erase count board or instrument count sheet immediately.

Sponges discarded from the field are collected in a pocketed sponge count bag.

If count is interrupted, the count is resumed with recounting of items currently being counted.

Items are counted with circulator visualizing field and verbally participating.

Hand off report to relief circulator includes report of any counted items removed from field and held for final counts.

Counts are documented starting at the field, then to mayo stand, to back table, and off field.

Counts are documented in EMR at the time they are completed.

Any waived counts are documented including reason for omission.

Appropriate actions are taken for count discrepancy (notify surgeon, notify charge nurse/ manager, x-ray).

Trash and linen bags are not removed from the OR until wound closures and counts are completed.