How to prevent retained foreign objects post-operatively?

Prevention of Retained Foreign Objects During Surgery

Implementing a standardized counting protocol and surgical safety checklist with time-out procedures is the most effective way to prevent retained surgical items, particularly sharp objects like metal towels. 1

Key Prevention Strategies

Pre-operative Phase

• Implement a standardized counting protocol that includes all surgical items (instruments, sponges, sharps, and other items) before the procedure begins 2
• Minimize distractions, noise, and interruptions during the counting process to ensure accuracy 2
• Document baseline counts in a standardized format accessible to all team members 2

Intra-operative Phase

• Perform mandatory time-out procedures before incision to verify all team members are aware of the procedure and counting protocols 2
• Conduct methodical counts at critical points during surgery:
  • Before the procedure begins
  • Before closure of a cavity within a cavity
  • Before wound closure begins
  • At skin closure
  • At the time of permanent relief of either the scrub person or circulating nurse 2, 3
• When handling sharp objects, perform X-ray examination before digital rectal examination to prevent accidental injury to the surgeon 4
• Use consistent counting methods with verbal confirmation between scrub and circulating nurses 2

Sign-out Phase

• Perform a comprehensive sign-out process that includes:
  • Verification that all counts are correct
  • Documentation of any count discrepancies and their resolution
  • Communication of any special considerations for post-operative care 2, 3

Management of Count Discrepancies

• If a count discrepancy occurs, immediately notify the surgeon and initiate a systematic search 2
• Perform a methodical wound exploration before closure 5
• Obtain high-resolution X-ray imaging before the patient leaves the operating room if there is any suspicion of a retained item 5
• Document all actions taken to resolve the discrepancy 2

Advanced Technologies for Prevention

• Consider implementing adjunct technologies to supplement manual counting:
  • Barcode scanning systems for surgical items 1
  • Radio-frequency identification (RFID) tagging for surgical instruments and sponges 1
  • Magnetic retrieval devices for metallic objects 1
  • Computer-assisted detection systems 1

Important Considerations and Pitfalls

• Relying solely on counting is insufficient - 62% of retained foreign object events occur despite correct counts 5
• The most commonly retained items are sponges (68%), followed by miscellaneous items (20%), needles (9%), and instruments (3%) 5
• Retained surgical items can lead to significant morbidity, with 29.73% of patients experiencing serious complications 6
• Almost 95% of patients with retained items require additional surgery for removal 6

Institutional Approach

• Establish a non-punitive reporting system for both actual retained surgical item events and near-misses 1
• Conduct regular team training on prevention protocols 2
• Perform routine audits of compliance with counting protocols 2
• Implement a proactive multimodal approach that focuses on improving team communication and institutional support systems 1

By implementing these comprehensive prevention strategies, healthcare facilities can significantly reduce the risk of retained surgical items and improve patient safety outcomes 1, 2.