Understanding retained surgical items (RSI): importance, prevention, and AORN Guidelines

When it comes to patient safety in the operating room, one of the most critical concerns is the prevention of retained surgical items (RSIs). These are objects left inside a patient’s body after surgery, such as sponges, instruments, or other materials. RSIs can lead to severe complications, including infections, pain, and even additional surgeries. In the worst cases, they can be life-threatening.

What are retained surgical items (RSIs)?

Retained Surgical Items (RSIs) refer to any unintended foreign object or portion of an object left inside a patient’s body after surgery. The most common RSIs are surgical sponges, but instruments, needles, and other small items can also be left behind. Despite advancements in surgical practices and the implementation of safety protocols, RSIs remain a preventable medical error that continues to occur during invasive procedures.

RSIs are classified as Never Events—serious, largely preventable patient safety incidents that should never occur in a healthcare setting. Their occurrence not only endangers patients but also exposes healthcare facilities to legal liabilities, financial penalties, and damage to their reputation.

Why is RSI prevention crucial?

The presence of an RSI can lead to devastating consequences for patients and healthcare teams. Patients may suffer from a range of complications, including:

• infections, which can be life-threatening,
• prolonged hospital stays and additional surgical procedures to remove the item, and
• chronic pain and impaired quality of life.

For the surgical team, not only can RSIs result in lawsuits, loss of trust, and increased scrutiny from regulatory bodies, but they also take an emotional toll on the care team. Thus, meticulous prevention of RSIs is paramount for both patient outcomes and the overall integrity of the healthcare system.

How do AORN Guidelines help perioperative nurses with RSI prevention?

AORN’s comprehensive guidelines provide clear and actionable steps that perioperative teams can take to prevent RSIs. These guidelines cover various aspects of surgical procedures, including best practices for counting, technology integration, and effective team communication.

Key aspects of AORN’s Guidelines on RSI prevention:

1. Standardized counting procedures

   AORN emphasizes the importance of standardized counting procedures before, during, and after surgical procedures. The guidelines recommend performing initial counts, additional counts during handoffs, and final counts before wound closure. If any discrepancies are identified, the entire surgical team is responsible for resolving them before the patient leaves the operating room.

2. Team communication and accountability

   Effective communication and shared accountability among the surgical team are critical components of RSI prevention. AORN guidelines stress that every team member has a role in ensuring accurate counts, from scrub personnel and circulating nurses to surgeons. Clear, assertive communication should be encouraged to avoid misunderstandings or errors during high-pressure situations.

3. Use of adjunct technology

   AORN recommends the integration of adjunct technology such as radiofrequency identification (RFID) tags, barcoding systems, and X-ray verification to complement manual counting. These technologies offer an added layer of safety by providing real-time tracking and identification of surgical items, reducing the likelihood of human error.

4. Education and training

   AORN’s guidelines emphasize continuous education and training for perioperative staff. Regular training sessions on counting protocols, updates on new technologies, and simulations of potential RSI scenarios help reinforce best practices and prepare teams for real-life challenges.

Patient safety and retained surgical items

AORN’s guidelines offer valuable tools and insights that support perioperative nurses in implementing best practices for preventing retained surgical items and ensuring high-quality care in the operating room. By adhering to standardized counting procedures, fostering strong team communication, and incorporating technology, surgical teams can minimize the risk of RSIs for optimal patient outcomes. As we continue to advance in surgical practices, AORN continually assesses the growing body of research to guide perioperative nurses toward safer, more efficient, patient-centered care. In addition to the AORN Guidelines, the AORN Center of Excellence in Surgical Safety: Prevention of RSI is a comprehensive program designed to help healthcare facilities prevent Retained Surgical Items (RSIs). It offers a team-based approach to education, training, and quality improvement initiatives

When and where are the AORN Guidelines Workshops?

AORN Guidelines Workshops are in-person, interactive educational events designed to provide perioperative team members with a deep understanding of the latest AORN Guidelines for Perioperative Practice.

These workshops offer:

• In-depth exploration of recent updates to the AORN Guidelines
• Practical tips for implementing evidence-based best practices in the OR
• Hands-on demonstrations of the newest OR technologies
• Networking opportunities with fellow perioperative professionals

By attending an AORN Guidelines Workshop, participants can enhance their knowledge, skills, and confidence in delivering optimal patient care.

Guidelines Workshops event information