What is the responsibility of the surgical team when a nurse suspects a retained surgical pack and the surgeon refuses to perform an x-ray to confirm before closing the surgical site?

Responsibility for Retained Surgical Items in the Operating Room

The entire operation team is collectively responsible for the mistake of the missed surgical pack, making option C the correct answer. 1

Team Responsibility for Surgical Safety

The prevention of retained surgical items requires a consistent, multidisciplinary approach with shared accountability among all perioperative personnel. While individual roles have specific responsibilities, the overall safety of the patient is a collective duty:

• The surgeon, as the team leader, bears significant responsibility for ensuring all items are accounted for before closure
• The nursing staff is responsible for maintaining accurate counts and communicating discrepancies
• All team members share responsibility for maintaining a non-hierarchical safety culture where safety concerns can be raised and addressed

Analysis of the Scenario

In this case, several critical failures occurred:

1. Communication breakdown: The nurse correctly identified a potential safety issue (missing pack) but the surgeon dismissed this concern
2. Hierarchical barrier: The surgeon's invocation of experience ("20 years") created a power dynamic that prevented proper safety protocol implementation
3. Failure to follow standardized counting procedures: The team did not resolve the count discrepancy before closure
4. Lack of imaging: When counts are incorrect, x-ray confirmation should be mandatory before closure

Why Each Option Is or Is Not Correct

• Option A (Surgeon must be blamed): While the surgeon made a serious error in judgment by refusing the x-ray, focusing blame on one individual fails to recognize the systemic nature of patient safety. The entire team shares responsibility. 1

• Option B (Nurse must insist): Although the nurse should have been more assertive, placing sole responsibility on the nurse ignores the power dynamics and the collective responsibility of the team. 1

• Option C (Operation team is responsible): This is correct. Guidelines emphasize that preventing retained surgical items requires shared accountability among all perioperative personnel. 1

• Option D (Head nurse has to write an OVR): While documentation is important after an incident, this answer focuses on administrative procedure rather than addressing the fundamental issue of collective responsibility.

Creating a Culture of Surgical Safety

To prevent similar incidents:

• Implement standardized counting procedures for all surgical items 1
• Establish clear protocols for reconciling count discrepancies, including mandatory imaging 1
• Create an environment where any team member can stop a procedure for safety concerns 1
• Develop institutional protocols for addressing situations where safety concerns are dismissed 1

Key Takeaway

The prevention of retained surgical items requires a non-hierarchical safety culture where experience does not override safety protocols. All team members must feel empowered to speak up when safety concerns arise, and standardized procedures must be followed regardless of seniority or experience. In this case, the entire operation team bears responsibility for the adverse outcome.