Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Ngan HT(1), Lo SHS(1)
Affiliation :
The Nethersole School of Nursing, The Chinese University of Hong Kong
Introduction :
Forgotten sponges, needles, instruments - the threat of unintentional retained surgical items (RSIs) lurks unseen within operating rooms worldwide. Despite being classified as "never events" by health authorities, these preventable occurrences persist, leaving a trail of physical and emotional wounds on patients and financial burdens on healthcare systems.
Statistics paint a grim picture. Each year, roughly 1 in 7,000 surgeries are marred by RSIs, causing excruciating pain, prolonged hospitalization, and even death (Primiano et al., 2020). While advancements like radiofrequency sponges have brought relief to the issue of soft item retention, a worrying trend of hard items such as needles and instruments slipping through the cracks continues (Weprin et al., 2021). These silent offenders can remain undetected for years, potentially sparking infections, reoperation, and unimaginable suffering.
The factors fueling this persistent threat are diverse. Emergency procedures, lengthy surgeries, increased BMI, and unexpected circumstances like bleeding or team changes can all heighten the risk (Moffatt-Bruce et al., 2014). Often, the culprit lies in human error, inadequate protocols, miscommunication, and inconsistently applied counting practices (Weprin et al., 2021).
Beyond the immediate physical harm, the medicolegal repercussions of RSIs are significant. Deemed medical malpractice due to their preventable nature, these incidents can lead to hefty lawsuits and tarnished reputations for hospitals. The financial toll is staggering, with claims for permanent injuries exceeding USD2 million per case (Goodwin, 2018).
Amidst this grim landscape, surgical counting emerges as a beacon of hope. This meticulous manual process, meticulously conducted by perioperative nurses, remains the cornerstone of RSI prevention (WHO, 2009). While technological advancements like x-rays and RFID hold promise, their limitations and cost make manual counting an indispensable first line of defense (Williams et al., 2014).
However, questions remain concerning the efficacy and accuracy of manual counting. How can we refine this crucial practice to better inform evidence-based protocols and ultimately eradicate RSIs? This question forms the heart of our investigation, and it is towards this answer that we embark on this critical exploration.
By delving into Freitas et al.'s 2016 review and other relevant research, we aim to illuminate the current state of knowledge regarding surgical counting, and identify potential avenues for improvement. Ultimately, our goal is to equip healthcare professionals with the tools and insights needed to transform counting from a necessary routine into a potent weapon against the scourge of RSIs.
Objectives :
This integrative review fills this gap by specifically delving into the manual surgical counting process of perioperative nurses and its impact on RSI prevention. This review takes a focused approach, recognizing the pivotal role nurses play in managing and performing surgical counts. This in-depth exploration aims to yield valuable insights that can inform implementation strategies and improve current practices.
To date, no review has comprehensively examined the interplay between manual surgical counting by perioperative nurses and RSI prevention. This integrative review therefore addresses this critical knowledge gap by analyzing existing evidence with critically review the available literature on the surgical counting process, focusing on factors influencing its accuracy and efficacy. Highlighting the role of nurses with their specific responsibilities and challenges faced by perioperative nurses in performing surgical counts. Identifying areas for improvement with pinpoint specific knowledge gaps and areas demanding further research to optimize counting practices. Proposing evidence-based solutions which aim to translate research findings into concrete recommendations for enhancing the effectiveness and standardization of manual counting procedures.
Methodology :
Seeking answers to prevent retained surgical items (RSIs), this integrative review delves into the world of manual surgical counting. To tackle this crucial question, a comprehensive search was conducted across PubMed, Medline, EMBASE, CINHAL, and Chinese databases. Utilizing keywords like "retained surgical item," "surgical counting," and "perioperative setting," the quest narrowed down to relevant articles published between 2013 and 2023, ensuring access to recent advancements.
Focus honed on adult patients in hospital settings, excluding ambulatory and outpatient situations, the review aimed to capture the specific nuances of operating room protocols and the critical role of perioperative nurses.
Three interventions formed the heart of the investigation:
Manual surgical counting implementation: This core practice emphasizes meticulous, documented counting of items before and after surgery, fostering team involvement and accuracy.
Standardization of the counting process: Building on robust protocols, this intervention seeks to establish clear guidelines, checklists, and defined roles for each team member, minimizing confusion and fostering consistency.
Enhanced counting through training and communication: Recognizing the human element, this approach highlights training programs and effective communication strategies to equip staff with the knowledge and skills needed for flawless counting and seamless information exchange.
Measuring the success of these interventions goes beyond solely preventing RSIs. The review also considers indicators of counting accuracy, near-miss events, and re-counting as valuable insights into the effectiveness of various methods. While technological interventions fall outside the scope of this primary focus on manual counting, pre-intervention RSI rates serve as a crucial baseline for comparison.
Quantitative studies, such as non-randomized controlled trials and pre-post interventional studies, provide the solid ground for analysis. Excluding abstracts, letters, and reviews ensures sufficient detail to critically evaluate the interventions and their impact.
By meticulously dissecting this body of research, the review aspires to illuminate the most effective strategies for optimizing manual surgical counting. This, in turn, paves the way for developing evidence-based protocols and ultimately safeguarding patients from the devastating consequences of RSIs.
Result & Outcome :
Retained surgical items (RSIs) lurk unseen in operating rooms, silently jeopardizing patient safety. This review delves into nine studies to illuminate strategies for optimizing manual surgical counting and minimizing this threat.
Three key themes emerged:
1. Multidisciplinary Approach: Collaboration takes center stage, with studies like Duggan et al. (2018) showcasing the success of task forces comprising diverse expertise - nurses, surgeons, quality specialists. Drawing on methods from high-reliability industries, these teams holistically analyze past incidents, design targeted interventions, and foster sustained engagement, paving the way for significant RSI reductions.
2. Communication is Key: Recognizing the vital role of communication breakdowns in RSIs, studies like Lean et al. (2018) focused on improving handovers, leading to fewer near misses and decreased RSIs. TeamSTEPPS training, with its emphasis on clear communication, pre-procedure briefings, and situational awareness (Kaplan et al., 2022; Rhee et al., 2017), empowers teams to catch potential errors before they become critical.
3. Knowledge is Power: Filling the knowledge gap through training and education programs emerged as a powerful strategy. Gomes et al.'s (2021) multifaceted approach, encompassing audits, educational programs, simulation training, and ongoing assessments, effectively shifted the focus from mere counting to a broader culture of RSI prevention.
However, limitations warrant attention. The majority of studies were quality improvement projects, highlighting the need for robust research to solidify evidence. The future demands tailored protocols that consider cultural nuances and specific environments, alongside exploring the effectiveness of team training, robust feedback systems, and continuous improvement initiatives.
Technology too, must evolve. With hard items emerging as the main culprits, research must prioritize novel detection and prevention strategies beyond traditional sponge detection. Integrating electronic counting systems with comprehensive item accounting holds immense promise.
Finally, open communication and a non-punitive approach towards standardized reporting systems are crucial. Transparency with patients regarding RSIs builds trust and empowers informed decision-making.
By optimizing counting practices, embracing technological advancements, and fostering a culture of open communication and continuous learning, we can collectively write a future where RSIs become a mere whisper in the annals of surgical history, and patient safety reigns supreme.
