In the year before our healthcare system implemented a sponge management system, our 36 ORs saw 13 incidents of retained sponges. In each case, the manual counts were correct. What that says is, although 13 people were doing the right thing, patients were still at risk. While manual closing counts are the standard of care, AORN estimates 76% to 88% of retained objects follow counts that turn out to be falsely correct. Over the next few pages, we're going to review the sponge management systems that double-check the accuracy of your closing counts, including the product we bought about 4 years ago that's kept us free of retained object incidents ever since, and even prevented 3 incidents, in which our counts were correct, but our devices detected retained sponges.

Visible, verifiable results
Sponge management systems use bar-coded or radiofrequency-tag-equipped sponges to verify counts. The technology behind these systems works in 1 of 2 ways, either by counting or detection.

• Counting systems. Sponges include bar codes that are manually scanned with and recorded by a computerized device as they are placed in the sterile field, then scanned again when they're removed from it. In this way, the closing count can be confirmed by an automated tally of how many sponges have been used.

• Detection systems. While counting systems can verify the count and alert surgical staff that a sponge is unaccounted for, they cannot locate missing sponges, which is one of the chief advantages of a detection system. These systems utilize sponges that incorporate a radiofrequency identification tag as well as a wand device, which signals an alert when it is passed over a sponge.

In the event that a counted sponge is missing at closing, scanning the wand over the patient, the area around the OR table, the trash bin or any other site can tell staffers where it ended up. Even if the closing count is correct — as it often is in retained object incidents — you can still scan the patient before closing as a final confirmation. One detection system incorporates a mat that goes between the patient and the OR table, which can perform a hands-free, full-body scan for sponges on command.

Back when we set out to evaluate sponge management technologies, we trialed all the systems available on the market. The product field is not so crowded that you won't be able to do the same. Pick the system that's easiest for your staff to assemble and use, and that's most compatible with the technological setup in your ORs. Like so many surgical safety devices and features, you want sponge management to be unobtrusive but routinely used.

A few extra pennies per sponge
In order for these systems to work, you'll need to use the specially bar-coded or RFID-tag augmented sponges from the system's manufacturer. That might cost you a couple of cents extra per sponge, but consider the costs of the risks you're seeking to avoid. Retained objects are significant, yet ultimately preventable errors that result in pain, infection, obstruction and other complications for the patient. And they'll cost your facility, surgeons and staff tens or even hundreds of thousands of dollars in treatment (since Medicare will not reimburse for re-operations), legal liability, and harm to professional reputation.

AORN's recommended practices state that manual counting alone is not a sufficient method of preventing retained sponges, and that we should evaluate assistive technology. As an administrator, the backup of a sponge management system is a solid assurance. Ask anyone who uses one, and they'll tell you what a difference it makes.

ClearCount Medical Solutions
SmartSponge Flex
www.clearcount.com
(888) 931-0787
Pricing: $9,995
FYI: ClearCount's radiofrequency identification-based platform provides a closed-loop reconciliation of sponge counts. All equipment and RFID tags are validated before use in each case and, during surgery, sponges are individually tracked from the initial check-in through the closing count. When called upon to do so, the detection wand can quickly locate missing sponges. To date, this combined counting and detection technology has made retained sponges a true "never event" in all the ORs in which it has been implemented. The SmartSponge Flex is a compact, portable, easy-to-use system that features bright, intuitive, touchscreen controls, an on-screen case review and a full electronic record of all cases.

RF Surgical Systems
RF Assure Detection System
www.rfsurg.com
(425) 283-0678
Pricing: no capital outlay, under $15 per procedure
FYI: The RF Assure Detection System makes the prevention of retained surgical sponges in the OR environment quick and easy. The Blair-Port Wand can rectify sponge count inconsistencies with the ability to locate the missing sponge in linen and trash bins around the sterile field, while also providing extended detection area coverage for bariatric and other critical cases. The Series 3000 Detection Mat provides automatic in-vivo detection through rapid 15-second scans, and doubles as a pressure-reduction device, as supported by AORN guidelines.

SurgiCount Medical
Safety-Sponge System
www.surgicountmedical.com
(877) 520-2300
Pricing: $10 to $12 per procedure
FYI: Nearly every retained sponge incident is rooted in the same problem: a false correct count. The Safety-Sponge System delivers a solution with its counting, tracking and documenting technology adjunct. Every Safety-Sponge includes a unique alphanumeric code embedded in a bar code that is scanned in and out during a procedure. The alphanumeric code prevents it from being counted twice, and from being counted out if it's not been counted in. An independent, 18-month study by the Mayo Clinic that included 87,000 surgical patients and 1,862,373 sponges saw no retained sponge events.

Technologies Solutions Group
Visi-Sponge
www.t-sgrp.com
(443) 542-5546
Pricing: projected at $7,500 to $15,000 per OR, depending on system
FYI: Planned for availability in the first quarter of 2013, the Visi-Sponge sponge tracking system uses RFID technology and a network-based system to seamlessly track, count and reconcile surgical sponges. Developed by a company with in-depth automation solutions experience, Visi-Sponge's patented technology incorporates electronic count sheets; front-, middle- and end-count reconciliation; report capability; and file manipulations and transfers.