Tap Into Technology to Prevent Retained Surgical Items

Using barcode scanning or radio-frequency identification to confirm the accuracy of manual counts will result in fewer sponges left inside patients, yet surgical professionals often push back on implementing these adjunct technologies. Some providers say it takes too long to log sponges in and out of cases, despite a study from the Mayo Clinic that shows using a sponge-accounting platform takes only a few seconds per case. Others say it’s redundant to the standard two-person count they perform, even though the potential for human error is obvious because only a minority of Retained Surgical Items (RSIs) take place because counts weren’t done. In most cases, counts were performed, but the teams simply got it wrong.

The time for resisting technology in efforts to prevent RSIs is over. The Association of periOperative Registered Nurses (AORN) will soon update its guidelines on the issue to recommend that adjunct technology — AORN does not favor a specific platform or product in the guidelines — should be used to supplement manual counting procedures for surgical soft goods. The current guidelines simply state that the technologies may be evaluated for use.

Two main technologies are currently available to help prevent RSIs:

• Barcoded sponges. The ID code embedded in individual sponges allows staff to scan each sponge that’s used into the automated system at the beginning of a procedure and scan them out before the case ends. The screen that shows the status of the sponges is housed on a mobile unit that’s about the size of an IV pole, which is also used to hang clear pouches in which staff place used sponges after they’ve come out of the patient. The patient should never leave the OR until all sponges that were logged into the system are logged back out after the procedure. The system records which member of the OR team did the scanning, the patient’s identity and the number of sponges used in the procedure.

• Sponge detection. Radio-frequency identification technology (RFID) allows you to prevent retained items by finding their exact location with a detection wand. RFID chips are embedded in each sponge. Patients lay on underbody detection mats that are activated at the end of cases while the wand is waved over them to determine if any of the sponges have been left inside. The wands can also locate sponges that wind up in a linen hamper or a trash can. In one case I did, the wand detected a missing sponge that had landed atop one of the surgeon’s shoes, a place where no one had thought to look. Without this technology, you must search for missing sponges that might be on the floor, in the trash or elsewhere, which takes time and can be very stressful. The ability for one staff member to wave a wand and locate the missing sponge is very valuable.

Any adjunct technology that takes away the potential for human error is very beneficial to the patient.

While barcode scanning platforms allow you to determine whether a sponge is missing, and RFID technology can allow you to locate a missing sponge, new systems are coming onto the market that can allow you to do both. The hybrid solution can identify, track and locate sponges. Some have additional important and time-saving features such as connecting the counts to the medical records and allowing OR teams to weigh the sponges as an effective way to measure the amount of blood patients have lost during procedures. This is a great development because you can have the sponge automatically weighed for you to gauge blood loss as you’re scanning it out and putting it into the pouch, which is one less thing to worry about while you’re tending to the patient and the rest of the case. Of course, any technology that takes away the potential for human error is very beneficial to the patient.  

Set up a room and invite two or three representatives of different products for your staff to trial. After you make your purchase, schedule an in-service day that educates everybody from scrub techs to physicians who will be involved in using the system. After that initial education, invite the product reps back and have them conduct hands-on demonstrations. Then have the staff do an immediate return demonstration, which means team members must explain what they were just taught, how they’re supposed to operate the new technology and why it’s important for them to use it.

Educators should provide extensive training in using adjunct technology to new hires and make them demonstrate how to use it before they complete orientation and team up with a preceptor in the operating room. Preceptors should be included in the education, so they’re aware of all policies and procedures as well. I also recommend using the AORN Perioperative 101 program, which contains a section on the prevention of RSIs.

After the initial training, have your educators and vendor rep make rounds in the operating rooms to answer staff questions. They should also observe the team in action and make sure the new technology is being used without problems. If there are any, they should provide immediate feedback and re-educate them on the spot.

The size of your facility should drive whether you launch the use of your chosen new technology incrementally or all at once. Larger facilities should consider using it for one surgical team or procedure at first, then expanding to other teams or surgical cases over a standard timeline set for implementation. Be sure to add the use of your new technology into your facility’s official policy, because staff simply aren’t going to use it if you don’t make it part of their required work. 

Some facilities might think the technology is too expensive, especially if they exclusively perform minimally invasive surgeries. While retained items remain rare, especially with minimally invasive procedures, it’s important to remember that you still need to perform counts during laparoscopic cases in the event you need to convert to an open procedure.