The primary responsibility of the perioperative nurse and the members of the surgical team is to ensure quality patient care and prevent any foreign bodies from being left in patients due to negligence. To achieve this, a standardized language consisting of the Perioperative Nursing Dataset (PNDS) is used, which includes perioperative nursing diagnoses, interventions, and outcomes. The expected outcome relevant to this recommended practice is to ensure that the patient is free of injuries related to retained sponges, instruments and sharps. A standardized counting procedure, following a logical sequence from large to small or from proximal to distal, helps achieve accuracy, efficiency and continuity among perioperative team members.
Altering a sponge invalidates subsequent counts and increases the risk of a portion being retained in the wound. Accounting for all instruments makes inventory control and patient safety easier. Removing all instruments from the room helps prevent possible incorrect counts in subsequent procedures. Policies and procedures also aid in the development of patient safety, quality assessment, and improvement activities.
Errors in surgical counting can result in the inadvertent retention of a surgical article, which is considered an unacceptable error due to the serious negative impact it can have on the health and safety of the patient. Therefore, surgeons and nurses must commit to common patient safety goals to ensure that surgical instruments, sponges and sutures are not retained in the patient's surgical wound. In these cases, the role of the instrument nurse, with responsibility for performing a count at certain stages of the surgical procedure, could be considered secondary to the need for surgical assistance. Opportunities for innovation in performing surgical counting should be considered, particularly in light of the fact that little time and effort has been devoted to developing a more reliable method of checking retained surgical articles other than manual counting. At the beginning of a surgical procedure, nurses manually counted the number of disposable items or surgical supplies that could be discarded at the end of the case, and the instruments, and recorded the count on a purpose-designed “count sheet”.