Standardized Counting Procedure to Prevent Retained Surgical Items
Introduction
Topic: Standardized Counting Procedure to Prevent Retained Surgical Items
Retained surgical items can cause severe harm to patients leading to infection, damage of body parts, death, pain, and perforation. Healthcare units should ensure the safety of patients to prevent death and health infections. Counting of the surgical items is critical in the prevention of the effects caused by the retained surgical items. However, there are human errors that are associated with the strategy more so in a busy environment where activities take place simultaneously (Williams, Tung, Steelman, Chang, & Szekendi, 2014). This research will assess the challenges associated with retained surgical items and propose the standardization of counting procedures as the appropriate strategy to prevent the challenges. The research will consider using both qualitative and quantitative methods to acquire reliable and valid information. Some of the methods that will be incorporated include the use of questionnaires, interview, observation, and analysis of the scholarly articles that date at least ten years ago. This research is essential for the healthcare system. It offered perfect recommendations for operational activities and ensures that patients are safe from injuries and death.
Retained Surgical Items are considered rare in occurrence. However, it is one of the most severe surgical complications. It is challenging to diagnose Retained Surgical Items, which makes it hard to identify precisely how often patients experience the issue. Scientists and institutions have failed to determine accurately when an item is retained. There is inconsistency on the definition of Retained Surgical Items, which leads to the absence of reporting and the difficulty in the interpretation of the reported cases. The incidence is unclear. According to Edel (2012), one among 1,000 to 1,500 abdominal procedures and one among 8,000 to 18,000 inpatient procedures in a year leads to retained surgical items in the United States. Healthcare systems should step up to ensure that they prevent the occurrences of retained surgical items. This healthcare problem can lead to death, physical disability, and emotional distress. There is a high mortality rate of approximately 35 percent that results from retained surgical items in the country. Retained surgical items affect patients and harm the medical teams and institutions, which are involved in the issue. Several deaths and physical disorders occur because of this healthcare challenge. The items that are left after surgery may cause liability and medical payments that affect the financial stability of the patients. This research aims at examining the available pieces of evidence and determine the effectiveness of standardized counting practice and the use of appropriate technological devices to prevent retained surgical items on patients.
Background
Several organizations have employed strategies to ensure the prevention of the Retained Surgical Items to prioritize the national safety of patients. Major organizations such as The Joint Commission and the American College of Surgeons have worked in hand to being instrumental in the creation of awareness to the safety of patients. Retained Surgical Items serve as a sentinel event, which is an unexpected occurrence that does not relate to the illness of patients or any underlying condition that may lead to death, psychological injuries, risks, and severe physical injuries. The health care system through The National Quality Forum has unintended the retention of any foreign object found in a patient after a surgical activity or any healthcare procedure to falling among the list of twenty-eight most severe reportable events.
On the other hand, the Centers for Medicare & Medicaid Services consider Retained Surgical Item as never events, which is currently available within the list of acquired conditions from the hospital, which demand immediate reporting and calls for the reimbursement of hospitals for other related care. Different states have different ways for reporting cases of Retained Surgical Items to the responsible regulating bodies, which makes it hard to identify the precise cause of the problem (Rowlands, & Steeves, 2010). The reporting discrepancies happen when there are different procedures on when and how to report the end of surgery and the presence of Retained Surgical Items. In 2013, Retained Surgical Items was recorded as the most frequently reported matter in healthcare. However, the issue fell to being the third most reported in the following year where delay in treatment and wrong site surgery took the lead.
According to previous researches, it is reported that several risk factors associate to Retained Surgical Items. Wood, & Conner (2017) connects retained Surgical Items with other surgical procedures that take place simultaneously on similar patients and surgical count that is not correct. On the other hand, Feldman (2011) states that the occurrence of Retained Surgical Items rise significantly due to a high number of emergency procedures such as the unexpected change of surgical procedures on patients who have high body mass indexes and when there is a breakdown in communication. Standardization of the surgical counts is considered as the best strategy that prevents retains Surgical Items completely. However, according to Moffatt-Bruce, Cook, Steinberg, & Stawicki (2014), a majority of Retained Surgical Items occur on the patients who have corrected the surgical counts, which offers the surgical team a false sense of security. Norton, Martin, & Micheli, (2012) ends up suggesting that depending on counting as the primary mechanism towards the prevention of Retained Surgical items is usually unreliable. According to previous research, there exists a correlation between the incidence of Retained Surgical Items and risk factors. This study suggests that the standardization of counting procedures and the appropriate use of technological devices that serve the counting procedures can reduce the number of Retained Surgical Items on patients.
Problem Statement
Retained surgical items is a severe healthcare occurrence, which leads to death, emotional stress, and physical disorder in patients. This medical problem serves as one of the most dangerous occurrences that take away the lives of patients. The healthcare system has deployed strategies to solve the problem. However, it has been difficult to identify when the problem occurs. Retained surgical items also lead to extreme and unnecessary expenditure for patients and families in solving the health considering that befall the surgical patients. The main question is whether standardized counting procedures are useful in the prevention of the retained surgical items.
Purpose of the Project
This project aims at assessing the cause of the retained surgical problem, its challenges and providing solid pieces of evidence that support the standardization of counting procedures as a reliable method to prevent retained surgical items. It provides recommendations for healthcare centers on how to prevent this deadly challenge that claims the lives of patients and affects the physical conditions of the patients.
Objectives
Identifying the cause of retained surgical items
Assessing the consequences associated with retained surgical items
Identifying the risk factors of retained surgical items
Explaining the everyday occurrences of retained surgical items
Explaining the correct counting procedures that prevent retained surgical items
Discussing the effectiveness of standardizing counting procedures for solving the problem
Clinical Questions
What entails standardize counting procedures?
What are the causes, effects, and risks associated with retained surgical items?
How effective is the use of standardized counting procedures in the prevention of retained surgical items?
What are the errors associated with the use of standardized counting procedures?
Scientific Knowledge on Retained Surgical Items
Research records that retained surgical items such as the needles, instruments, and sponges occur in 1:5500 surgeries. The sponges account for approximately 48 percent to 69 percent of the medical items that are retained in patients’ bodies. The cavity that is mostly involved and affected by the condition is the abdomen. Retained surgical items lead to reoperations, infections, death, bowel obstruction, prolonged stay, and visceral perforation. Reoperation is the most common effect of the retained surgical item. Several risk factors are led to retained surgical items, which include high BMI, emergency surgeries, and incorrect count reports, several surgical procedures at the same time, and unplanned changes and events in operation.
Healthcare systems should ensure to provide additional attention and care to surgical patients that are affected by the risk factors caused by retained surgical items to ensure that they prevent the occurrences of this challenge. This study aims at identifying the effectiveness of standardized counting procedures in the prevention of the retained surgical items on patients. There is a high percentage of cases related to retained surgical items, and the achievement of correct count serves as the best procedure to reduce the cases. The requirements for clinical practices, and there exists a high degree of count practice, which is inconsistent among healthcare workers.
Retained surgical instrument refers to any item that is left behind inadvertently in the body of a patient during surgery. Clinicians are warned severally on the dangers associated with the unintended retention of the foreign objects after several surgical procedures. The retained surgical items can cause death and infections, and emotional and physical harm on the surviving patients depending on the length of time retained and the object retained during surgery. The retained foreign objects are the most detected post-procedures through X-ray during healthcare follow-up visits, or whenever patients complain of discomfort and pain. The most common items left behind after surgical procedures include:
Soft items such as towels and sponges
Tiny miscellaneous items such as the unretrieved device fragments or components like the broken parts of instruments, parts of laparoscopic trocars, stapler components, pieces of drains, catheters, and guidewires.
Instruments, which are the most common malleable retractors.
Needles and sharp implements.
The healthcare systems are subjected to several expenses that include indemnity payments, legal defense, and operational costs. There is a high increase in incidents of death that result from retained surgical items. The incidents take place in the operating rooms, delivery and labor areas, the ambulatory surgery centers, and another area where invasive processes take place within the healthcare centers. The most common root cause of this problem includes the absence of procedures and policies, failure to comply with the present rules, hierarchy and intimidation, poor communication between physicians, staff, and patients, and incomplete or the inadequate staff education.
Medical researches submit that the most common risk factor include the mass index of the patients, unexpected or the anticipated changes during surgery, and urgent or the emergent processes. There are other risk factors such as intra-abdominal surgery, where physicians carry out several surgeries at the same time. Other risk factors include the incorporation of several individuals during a single surgery activity, multiple staff turnover during surgery and the unexpected intraoperative development. Healthcare centers have employed manual counting procedures by the perioperative staff in the prevention of the retained surgical items. However, there are other errors experienced when solving the problem through standardize counting procedures. It has been reported that ten to fifteen percent error rate occurs whenever the healthcare staff involves counting sponges for operational processes. The most obvious strategy that solves the problem completely includes the improvement of the counting procedures. The surgical physicians should embrace the standardized practices to ensure that they sustain and develop reliable counting procedures that make sure that they are accountable for the medical items. The healthcare practitioners should ensure that they comply with the evidence-based practices that are documented within the recommendations and guidelines. Nevertheless, adoption of the practices that control and prevent healthcare challenges can be variable. The challenging aspect in the prevention of the retained surgical items through compliance with the healthcare guidelines includes the achievement of consistency in clinical practices within the emergency from the expectations.
The knowledge gap is one of the potential challenges that cause retained surgical items on patients. A gap in knowledge serves as the fixative of accurate counting of the surgical items. There is a need for accountability and consistency. Accountability on the number of surgical items placed in a patient’s wound reminds the healthcare practitioners on the need for counting procedures to prevent retained surgical items on patients. It is possible to improve compliance with guidelines through the participation of the infection preventionist, who is responsible for preventing surgical site infections as an outcome for the retained surgical items. It is possible for the retained surgical sponges to migrate from the abdomen to the thorax, bladder, stomach, or the intestine. This process is known as the transmural sponge migration, and it is associated with risks for infection development through a fistula or the abscess formation. The infections preventionists should ensure that there is adequate education to the surgical team on the possible risk infections that may affect patients from the retained surgical item. Healthcare leaders need to create a safety culture through system thinking, training, proactive risk assessment, and human factor analysis.
The healthcare should account for all surgical soft goods opened for the sterile field during procedures where the soft materials are used. The sharp and miscellaneous items should also be accounted for during procedures where they are used. All surgical instruments and other medical instruments should be accounted for during all procedures where there is the likelihood for the instrument to be retained. There should be appropriate measures that guarantee the prevention of device fragments. The healthcare providers should be careful to take standardized measures for the reconciliation of count discrepancies during the closing count and before the end of surgery. Surgery team should be responsible for taking action to locate the missing item whenever there is the identification of the discrepancy in a count. There should be clear documentation on the operational activities towards the prevention of retained surgical items. There should be clear procedures and policies that offer comprehensive prevention of the retained surgical items. The procedures should be reviewed often, revised accordingly, and should be accessed easily during the practice procedures. There should be active participation for the perioperative personnel in several quality insurance and performance improvement activities, which are consistent with healthcare organization plans towards the improvement of understanding and compliance to the processes and principles that guarantee the prevention if RSI. Surgical guidelines demands for procedures that ensure the limitation of noise, interruptions, and distractions during surgical counts.
Tissue Reactions to Retained Surgical Items
In cases of retained metals in the human body demands surgical implant because of the inert reaction of the human tissue. Gauze causes the fibrous response to the human tissue, which includes granuloma, adhesions, and encapsulation. The tissues also undergo exudative inflammatory response because of the presence of gauze in the body, where there occurs abscess and the chronic external or internal fistula. The migrate of sponges in parts such as the bladder, intestine, thorax, stomach, lungs, and the retroperitoneum leads to death, infection, non-sterile tissues, and sepsis. It is appropriate for the healthcare providers to carry out accurate counting of all the surgical processes before starting any procedures when dispensing into the sterile field, and upon the closing of the cavity within the cavity. During the closure of the cavities, the surgical team should ensure that they count all soft goods, sponges, and sharp objects accurately to ensure that there is no retained item in the patient’s body. Counting should also be done when closing the first layer and when undertaking the final closure of the body. The exceptions to instrument counting according to the facility policy includes complex procedures, which involve large numbers of instruments such as spinal fusion. It also includes trauma cases and the processes that demand complex instruments that have several small parts. Another exception is the procedure where the depth and width of the incision are too small to allow for the retention of the instrument.
Sponges should be radiopaque such as when towels are used inside the wound. Surgical doctors should consider using the pocketed sponge bag system. The surgical providers should ensure that they reconcile counts when confirmed by the surgeon and should be sure to the incorrect when they are not sure during the intentional packing of the sponges. Proper communication should be made whenever there is the transfer of this item.
It is the needles need to be counted regardless of their sixes during all procedures. It is proper to count them whenever the package is opened. The healthcare providers should not use any empty suture packages during the reconciliation of counts. It is not possible to identify the needs of less than 10mm using a radiograph.
Team Responsibility
The entire surgical team is responsible for delivering safe care to patients during operational activities. Every surgical team member is responsible for providing a good environment that guarantees safety and offers proper system approach that fosters the inter-professional collaboration that ensures the reduction of the risk factors that leads to retained surgical items. The surgical team is responsible for updating and standardizing the count procedures and policy for the reduction of the risks associated with retained surgical items. The nurses and doctors should participate in proper counts during certain phases of healthcare, which includes the initial count before allowing the patients into the Operation rooms, every time an item is added to the field, and during the closure of the final counts. The surgical team should ensure to use the standard sequence for the count and ensure all items counted and separated physically. The counting should be audible and concurrent. Recording should be on a standardized sheet and proper count board. All instruments should be inspected appropriately to make sure that they are intact before and after using them to ensure prevention retention for the device fragment.
The nurses should be alert whenever an instrument falls during surgical procedures, and all missing sponges and instruments should be searched keenly to ensure that they are found. The perioperative team should be alerted during the beginning and the end of every procedure involved in surgery. All missing sponges should be searched properly before ending the surgery to ensure that all items accounted for. All members should have an equal right to speak for the safety of the patients. Mistakes should not be assumed. The ability for the whole team to speak up concerning safety matters is proper for all the team members to delivering safe care to patients.
Distraction, Interruptions, and Noise
Guaranteeing a safe surgical condition incorporates making a situation that is free from diversions, commotion, and interferences amid first periods of patient consideration, including thorough checks. Diversions, clamor, and interferences rise the hazard for a retained surgical items by expanding the opportunity for exclusion (e.g., not including a thing, thinking a thing has just been tallied), influencing focus, and redirecting consideration from the present errand. The healthcare centers should ensure a quiet environment that prevents noise and other interruptions during standardized counting procedures before patients entering the operation rooms. There should be recounting process to ensure accuracy. Understanding that contending requests could expand the hazard for an inaccurate check. The surgical team ought not to start the procedure until after the end counts had been verified right, reducing contending requests on the human services group.
Consistent Counting Procedures
The standardized procedures and practices build the safety of patients and diminish the potential for damage and unfavorable results. The standardization of all the aspects involved in the surgical count in the prevention of the retained surgical items involves the determination of the appropriate individuals to carry out the surgical counts, the appropriate time for carrying out the count, and the right sequence for undertaking the count (Williams, Tung, Steelman, Chang, & Szekendi, 2014). Associations should set up a standardized methodology for the aversion of RSIs that incorporates these components. Two people ought to be associated with the check, one of whom is the RN circulator. The nurses and the RN circulator ought to be associated with the majority of the tallies alongside the careful technologist doled out to be the scour individual.
Amid every one of the counts, the two people ought to see the checked things simultaneously. Things that ought to be incorporated into the careful check to diminish the hazard for an RSI incorporate radiopaque wipes, sharps, different things, and instruments, as controlled by the association’s arrangement. Counts should be done at specific periods of the surgical continuum to diminish the hazard for retained surgical items. These specific stages incorporate before the start of the technique to decide a benchmark include:
Whenever new things are added to the sterile field.
Before the conclusion of a cavity within a cavity (e.g., the uterus)
At entry point site conclusion (i.e., the end count)
At the closure of skin (i.e., the final county).
Before changeless alleviation of staff individuals
Whenever a disparity is identified.
It is appropriate to carry out counts before conveying the patient to the operation room, amid the system when other sutures and laparotomy wipes are added to the field, at the time the specialist began to close the entry point site, and during closure of the skin.
Items that are counted ought to be recorded quickly, and the running absolute kept up in one area, on either an institutionalized count worksheet or a counting board. Amid the precedent situation, all account should be recorded quickly on the institutionalized count worksheet and count board. Likewise, the instrument that falls onto the floor amid the system should be put on the base of the case truck to be incorporated into the consequent tallies, which is the assigned area for putting the dropped instrument. Counts ought to continue in an institutionalized succession that pursues a legitimate movement. For counts that happened after the start of the methodology should advance proximally to distal from the patient, beginning with the sterile field, at that point moving to the Mayo stand and the back table, and finishing with any things of the sterile field.
Count Discrepancy and Its Reconciliation
Count discrepancy takes place whenever the quantity of the available items, which are reflected on the counting board does not match the quantity counted on and off the sterile field. Discrepancies in counting can occur at any time during the surgical processes because of several reasons. Count discrepancies may occur because of miscounting of items, errors in the written documentation, misplacement of items, and human errors such as poor practices. The risk factors that contribute to counting discrepancies include more extended procedures, unplanned changes within procedures, changes in personnel, and complex procedures. The whole perioperative team is accountable for making the next address on the occurrence of count discrepancy to ensure that they reconcile the count. Some of the appropriate immediate actions that ensure the reconciliation of count discrepancies include:
Verbal notification to the entire perioperative team concerning the items of concern
Carrying out a recounting procedure for the items used in surgery
Carrying out a broad search on the entire operating room including the linen receptacles, the floor, trash, and kick buckets.
Requesting help from additional personnel concerning the location of the items.
Searching the sterile field, the instrument trays, the drape folds, and the back table.
Suspending the closure of the incision site whenever the there condition of the patient permits.
Exploring the site for incision
Making a proper plan for the anesthetic progression to prevent pressuring the surgical team on the performance of insufficient count resolution.
Proper documentation of the unresolved count discrepancies on the records of the patient.
The surgical team should ensure that they recount all the items used to ensure that there is no discount on the instrument. Cases where an item is missing calls for the extensive search to ensure that the item is found and be sure that it is not retained in the patient’s body before the skin closure.
Improvement of Performance
A constant quality improvement approach enables associations to all the more likely comprehend unfriendly occasions and make a setting in which to mindfully actualize changes that can, at last, improve the quality and wellbeing of the consideration conveyed. At the point when inter-professional groups take an interest in a top to bottom audit of antagonistic occasions and cautiously investigate forms without crediting fault, excellent frameworks for counteractive action of medicinal mistakes can be created (Stawicki, Moffatt-Bruce, Ahmed, Anderson III, Balija, Bernescu, & Gracias, 2013). The operation room is an incredibly overwhelming and multifaceted condition. Perioperative groups can effectively overhaul frameworks to keep future unfriendly occasions from happening when they comprehend the occasions and framework structures encompassing an antagonistic occasion such as retained surgical item. Any patient who goes through surgery might be in danger of facing a retained surgical item (Williams, Tung, Steelman, Chang, & Szekendi, 2014). The perioperative RN must know and see best practices identified with the aversion of RSIs to think securely about the patient all through the perioperative continuum. Perioperative RNs ought to seek proactively after data concerning anticipation endeavors to incorporate group obligation; the impact of diversions, clamor, and interferences; predictable tallying techniques; standardized procedures for accommodating inconsistencies; and continuous quality improvement. By having an intensive comprehension of anticipation techniques for RSIs, perioperative RNs can convey protected, different patient consideration.
Zero-tolerance and quality improvement are some of the best strategies to prevent retained surgical items. The development of evidence-based procedures and policies for the operation room teams is appropriate to ensure accountability during surgery. Counting of the surgical items that could have been sewn accidentally inside a patient is vital for proper operations. It is recommended that the counting operation should involve more than one person for accuracy and proper accountability. The counting should be visible and audible. The procedure should come before, during, and after surgery to improve on accuracy. Repeating the process reduces the chances of errors. The potential of the retained objects determine the procedures to be involved in opening and closing counts. It is proper for the clinicians to carry out good inspections of the instruments to be used for surgery to test any signs of breakage to prevent any piece of the object from snapping off inside the body of the patient. The clinicians should not assume the use of advanced technology through the process. Technology improves accuracy and forms part of the solution to the problem. The surgical doctors and nurses can consider using the surgical instruments and other supplies, which are made of the radio-opaque materials that allow them to show up clearly through x-rays whenever the hunt is on (Stawicki, Moffatt-Bruce, Ahmed, Anderson III, Balija, Bernescu, & Gracias, 2013). Healthcare centers can strategize to use the sponges, which are tagged with radio frequency identification devices to ensure that they keep track of them. However, the challenge is that some hospitals are not financially stable to afford this technology. The operation room team should take time for a briefing before undertaking any procedure and should carry out debriefing afterward to allow members to raise any safety concern.
The primary line of barrier in disposing of RSIs is a protected, exhaustive, and successful procedure of monitoring wipes, instruments, needles, and different incidental things utilized in a medical procedure and counteracting tally errors. Manual checking is subject to human execution and biological components that may influence the resulting relates, which builds the opportunity for a human mistake. The most continuous purpose behind RSIs is human blunder brought about by a breakdown in correspondence and broken procedures. Research demonstrates that correspondence breakdown, diversions, contending requests, generation weight, and absence of outstanding staff are primary factors that can prompt checking blunders. The values of the operation room likewise can influence how the assignments are performed. For instance, groups that experience struggle, correspondence breakdown, or obstructions identified with pecking order might be bound to pursue erroneous or unsatisfactory tallying rehearses.
Wrong documentation of the instruments and sponges used in surgery is a potential contributor to the retained surgical items. Nurses carry out the documentation in different ways, and there is a need for a standard counting procedure that applies to all healthcare units. It is appropriate to reinforce the count practice updates and expectations through education programs for the healthcare staff. The education program involves sequence counting. Nurses ought to work together to ensure a streamlined instrument kits to improve the instrument count procedure and ensure the removal of redundant and obsolete items. They are also responsible for updating the instrument count sheets to ensure proper facilitation of a smooth flow through counting.
Recording after performing initial counts is appropriate to establish a baseline that allows for subsequent counts on all the performed procedures. The nurses should ensure voluntary and consistent adherence and application to the standardized procedures that prevent the retention of surgical items. Counting of the miscellaneous and sharp items used in surgery is critical for the prevention of item retention and reduction of the risks of injuries to patients and the healthcare personnel. Laundry, operating room, housekeeping, morgue, and sterile processing personnel are at high-risk needlestick injuries that result in exposure to the infections that are transmissible. There are numerous revealed instances of needle stick-related wounds to the social insurance workforce. A standardized include methodology helps with accomplishing precision, proficiency, and congruity among perioperative colleagues. Investigations of human mistake have appeared numerous blunders include some deviation from routine practice.
Simultaneous confirmation of counts by two people may diminish the hazard for check inconsistencies. Extra sharps and incidental things added to the field ought to be checked when they are included and recorded as a significant aspect of the tally documentation. Checking and recording sharps and random things as they are added to the field may decrease the danger of mistake and may keep a mistaken tally at the finish of the technique (Stawicki, Moffatt-Bruce, Ahmed, Anderson III, Balija, Bernescu, & Gracias, 2013). Suture needles ought to be tallied when the bundle is opened, checked by the clean individual, and recorded. Survey each needle will help guarantee a precise needle check. The real number of needles may not be equivalent to the number of void bundles. The scour individual should represent and restrict all sharps on the sterile field until the last check is accommodated.
Unconfined sharps staying on the sterile field might be accidentally brought into the entry point, dropped on the floor, or infiltrate boundaries. Control and regulation of sharps may limit the danger of needle stick damage to the workforce just as retained surgical items. Utilized sharps on the sterile field ought to be kept in a safe cut holder. Gathering utilized needles in a safe cut holder guarantees their control on the sterile field and helps with checking at the finish of the method. Sharps counts ought to be led in a similar succession each time as characterized by the human services association. The sequence for counting ought to be in a legitimate movement. A standardized include methodology helps with accomplishing precision, proficiency, and progression among perioperative colleagues. Investigations of human mistake have appeared numerous blunders include some deviation from routine practice. The scour individual ought to survey the state of sharps or different things and confirm that they are unblemished when coming back from the useful site. Breakage or partition of parts can happen amid open and insignificantly intrusive surgeries. Confirming that every single broken part are available or represented anticipates RSIs inside the patient.
Counting of instruments at the instrument assembly set gives an essential stock reference to the instrument set. However, it is not viewed as the underlying count before the surgery. A check performed outside of the operating room that is viewed as an underlying count builds the number of factors that can add to a count inconsistency and superfluously stretches out the obligation to staff not engaged with direct patient consideration — counting singular bits of gathered instruments when a system lessens the danger of deserting a piece if the instrument progresses toward becoming dismantled under any circumstances. Removable instrument parts can be deliberately expelled or turned out to be free and fall into the injury, onto, or off the sterile field. Extra instruments ought to be considered and recorded piece of the tally documentation when they are added to the sterile field. Considering and recording instruments they are added to the sterile field may keep an erroneous tally at the finish of the methodology. Individuals from the conservative group should represent instruments completely that may have broken or turned out to be isolated inside the limits of the particular site.
Use of Technology in Count Procedure
The implementation of a mechanism that evaluates and selects the emerging and existing adjunct technology should be in place. The perioperative personnel should prioritize the safety of the patients. This team should ensure good participation in the selection of proper medical products and devices for operational activities. Adjunct technology should be used appropriately to prevent retained surgical items on patients. The rapid changing technology makes it possible to acquire proper machinery that supports the counting procedures in the prevention of retained surgical items (Wood, Conner, 2017). The products standardization and their value analysis procedures should be in line with the reliable and functional products that offer safety, are friendly to the environment, are cost-effective, and promotes quality care for patients. Technology is suitable in the verification of the count accuracy. A combination of the standardized processes and the manual counting builds on proper communication, radiological verification, the use of adjuncts, and multidisciplinary teamwork. It reduces cases of retained surgical items.
The significance of the Project
The findings from this research will be beneficial to the healthcare centers and the surgical providers on the appropriate ways to prevent the occurrence of retained surgical items through standardized counting procedures, which improves on accuracy. Retained surgical items is a severe challenge that affects patients and surgical providers. This condition may claim the lives of patients or cause them to suffer physical damages. The research will ensure that healthcare providers are accurate and responsible in their operational activities by providing maximum safety to patients. It will also ensure that there are no occurrences of unnecessary expenditure from seeking medical care. It will educate the healthcare provides on the best way to minimize medical errors and ensure the safety of the patients. It will build on accountability during surgical operations. The healthcare centers, which will apply the recommendations offered in this research will be able to reduce cases of retained surgical items, unnecessary expenditure, the death of patients, and will ensure accuracy in their operations. This study will assist the researchers to reveal the causes of retained surgical items, its risks, and the possible ways of prevention.
Retained surgical items have claimed the lives of several patients. It has led to emergency operations, which have ended up in the interference of human bodies. So many families have been subjected to emotional torture and unnecessary expenses because of this problem. This study provides an in-depth analysis of the modes that standardized counting prevents the problem and ensures the accuracy of healthcare providers and the safety of patients.
Rational For Methodology
Sampling
This research will consider the random sampling method. Random sampling guarantees the credibility of the given research. It creates an element of fairness in the distribution of the research participants. Every individual is driven by the need for efficiency in such a sample population. Non-probability sampling is also incorporated in this type of sampling. The participants in this research will be sampled from a population of surgical nurses and physicians. They will also include patients who have undergone surgery as well as families of patients who went through surgery at one point in life. All participants will be chosen at random to ensure equal participation. The sampling will consider any gender. However, the participants will include individuals of above fifteen years. They will be selected from different states.
Further, age limits will be established regarding the participants in this research. Ethical considerations restrict the involvement of minors in research and in case a minor is to be involved in any research, parental consent will be established. Sampling strategies will be useful in providing detailed and relevant information regarding all the factors related to the case. Every sampling method will be used based on its efficiency levels in defining the sample population. The importance of the sample population is inherent in the possible outcomes or result of the research.
Data Collection
The collection of data will be defined by the strategies that will be adopted in the sampling and analysis of this data. Therefore, approaches such as questionnaire, surveys, and interviews will be used in the collection of data. Some of the questionnaires could be administered online while others may necessitate one on one interviews. Participant observation will also be a significant approach to collecting data. This approach is more efficient based on the setting of the data collection. Every data collection method will be picked based on the relevance of the specific approach and its link to the data that has been collected. The research will have a proper questionnaire that involves open-ended questions, which are transparent to read, understand, and respond to. Interviews will be carried out appropriately. The use of interviews if efficient to acquire relevant information because it allows for a direct approach and interaction with the target group. It allows the research team to read the mood and feelings of the participants and gives the participants the chance to open up and provide valid information. Other information will be collected from relevant scholarly articles on the subject. The articles to be considered will be latest and from valid sources. They will be of at least ten years before. The articles will be used to back up the numerical information and give clear evidence for the research to build on credibility and accuracy.
The period for the Research
The research will take place for four months. The period set for the research will be determined by the cost of the research and the need to have adequate and reliable information. Six months is a proper period to ensure that the research is not a constraint to unnecessary expenditure and that the information collected is relevant and enough. The first month will be set to reach out to the participants and educating them on the research and its objectives. The following three months will be used to collect data and organize them effectively for analysis. The last two months will be used to analyze the information collected appropriately. This period will include time to offer recommendations, prove the analysis and make conclusions for the research. This time set is reasonable and enough for complete research according to the stated objectives.
Analysis of Data
Data analysis will be determined by the specific elements of data that will be adopted in the research. The implication is that various strategies will be adopted towards enhancing the acceptability and ease of analysis. Regression analysis and MECE principle are an essential analytical tool that will increase the efficiency of this analysis. These two will be critical strategies that will facilitate the analysis of the data that has been collected in this research. The analysis will consider the most credible information.
Nature of the Project Design
Validity will be an integral element of this research. The implication is that valid research can create the link inherent in any research process. Aspects such as cogency are crucial in the determination of the validity of the research. Every research must be hinged on the need for logicality the implication is that every research is set to determine specific aspects of knowledge that raise questions. Therefore, valid research must show enough evidence that the research has successfully managed to address the given elements that it was designed to address. Valid research must be sound regarding its approaches to the various areas of concern.
Further. Credibility will also be a central issue in this research that has been undertaken in an organization. It is more inclined towards the results of the research. The necessity of results should be believable. If the results seem believable, all the other aspects are also influenced, but if the reverse is the case, the entire research could be put in jeopardy.
This research will be reliable. Every research must show enough reason and the commitment towards addressing the possible concerns of the clients. In this case, the research will be centered on addressing the effectiveness of standardized counting in preventing retained surgical items. The reliability of research refers to the degree of the possibility of a repetition of given results with similar outcomes in any research. Reliability is influenced by all the three elements in the research starting from the researcher, the process and even the results of the research.
Ethical Consideration
The first step, in this case, will involve ascertaining the ages of participants. Every participant must meet the threshold for age, and any participant below the set limit will have to produce a copy of parental permission allowing him or her to participate in this research. Further, all the details like names will be protected and not revealed to the public. The identity of all participants must be protected at all costs. Ethical views also include informing these participants of their participation in an online survey. This will help in limiting the possibility of lawsuits among other concerns.
Assumptions, Limitations, and Delimitations for the Research
Assumptions
Assumptions are facts or statements that are considered valid, even though there is nothing to verify them. Assumptions in a research project are artifacts that are not within the control of a researcher, but if they lack in a study, it becomes inappropriate. There were some assumptions, which might pose a risk to the validity of the findings from the study. The assumptions for this research include:
Both qualitative and quantitative method will be the most suitable methodology for conducting the research. This will form an assumption the researcher’s side.
The participants in the study will genuinely provide information without biases.
The participants will be knowledgeable and articulate about their experience in providing reliable answers to the interview questions posed to them.
The themes in this study would appear from the participants’ response to interview questions presented to them.
Limitation
Limitations are shortcomings that are out of the researcher’s control. The limitations restrict the research methodology and conclusions. The limitations of the research include:
The sample size of the study participants. The research will consider a limitation on the potential of biases and prejudices by participants in responding to research questions. This could have altered the quality of this qualitative study.
The interviews might have experienced some discomfort on the disclosing of some information on the consequences experienced because of retained surgical items.
The timing of the study. The period set for the study will limit acquiring information from some of the affected patients.
The financial resources required to facilitate research activities will limit the in-depth collection and analysis of information. Lack of enough finance will not the research to conduct certain activities.
Limited access to relevant literature prevents an adequate collection of information.
Delimitations
Delimitations or limits of narrow the scope of the study. They are the restrictions within which the study is conducted to help the research maintain a focus within the scope. The delimitations in this research include.
Geographical boundaries. The study will be limited to healthcare providers, patients, and affected families from individual states.
All participants will be individuals above fifteen years only.
Summary
Retained surgical items can cause severe harm to patients leading to infection, damage of body parts, death, pain, and perforation. Healthcare units should ensure the safety of patients to prevent death and health infections. Standardized counting procedures on surgical items serve as the best strategy for the prevention of the effects caused by the retained surgical items. However, there are human errors that are associated with the strategy more so in a busy environment where activities take place simultaneously (Wood, Conner, 2017). This research will access the effectiveness of standardized counting procedures in the prevention of retained surgical items. The research will consider using both qualitative and quantitative methods to acquire reliable and valid information. Some of the methods that will be incorporated include the use of questionnaires, interview, observation, and analysis of the scholarly articles that date at least ten years ago. The recommendations and information offered from the research will be beneficial to the healthcare system on the prevention of retained surgical items. It will boost the accuracy of nurses and surgical doctors.
Reference
Cima, R. R., Kollengode, A., Clark, J., Pool, S., Weisbrod, C., Amstutz, G. J., & Deschamps, C. (2011). Using a data-matrix–coded sponge counting system across a surgical practice: impact after 18 months. The Joint Commission Journal on Quality and Patient Safety, 37(2), 51-AP3.
Copeland, A. W., Sanfey, H., & Collins, K. A. (2016). Retained Surgical Sponge (Gossypiboma) and other retained surgical items: Prevention and management.
Edel, E. M. (2012). Surgical count practice variability and the potential for retained surgical items. AORN Journal, 95(2), 228-238.
Feldman, D. L. (2011). Prevention of retained surgical items. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 78(6), 865-871.
Freitas, P. S., Silveira, R. C. D. C. P., Clark, A. M., & Galvão, C. M. (2016). Surgical count process for prevention of retained surgical items: an integrative review. Journal of clinical nursing, 25(13-14), 1835-1847.
Gibbs, V. C. (2011). Retained surgical items and minimally invasive surgery. World journal of surgery, 35(7), 1532-1539.
Goldberg, J. L., & Feldman, D. L. (2012). Implementing AORN recommended practices for prevention of retained surgical items. AORN Journal, 95(2), 205-219.
Gualniera, P., & Scurria, S. (2018). Retained surgical sponge: Medicolegal aspects. Legal Medicine, 31, 78-81.
Moffatt-Bruce, S. D., Cook, C. H., Steinberg, S. M., & Stawicki, S. P. (2014). Risk factors for retained surgical items: a meta-analysis and proposed risk stratification system. Journal of surgical research, 190(2), 429-436.
Norton, E. K., Martin, C., & Micheli, A. J. (2012). Patients count on it: an initiative to reduce incorrect counts and prevent retained surgical items. AORN Journal, 95(1), 109-121.
Rowlands, A., & Steeves, R. (2010). Incorrect surgical counts: a qualitative analysis. AORN Journal, 92(4), 410-419.
Stawicki, S. P., Cook, C. H., Anderson III, H. L., Chowayou, L., Cipolla, J., Ahmed, H. M., … & Adams, R. C. (2014). Natural history of retained surgical items supports the need for team training, early recognition, and prompt retrieval. The American Journal of Surgery, 208(1), 65-72.
Stawicki, S. P., Moffatt-Bruce, S. D., Ahmed, H. M., Anderson III, H. L., Balija, T. M., Bernescu, I., … & Gracias, V. H. (2013). Retained surgical items: a problem yet to be solved. Journal of the American College of Surgeons, 216(1), 15-22.
Williams, T. L., Tung, D. K., Steelman, V. M., Chang, P. K., & Szekendi, M. K. (2014). Retained surgical sponges: findings from incident reports and a cost-benefit analysis of radiofrequency technology. Journal of the American College of Surgeons, 219(3), 354-364.
Wood, A., & Conner, R. L. (2017). Guideline for prevention of retained surgical items. Guidelines for Perioperative Practice, 375-422.
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