Surgical Counts in the Delivery Room

Abstract

Poster Presentation Purpose for the Program An opportunity existed to reduce or eliminate the risk of retained surgical items (RSIs) in response to the Joint Commission's October Sentinel Event Alert regarding RSIs. Within perinatal nursing there is a keen awareness that a discrepancy exists between the approaches to surgical counts in the perioperative suite versus the vaginal delivery room. It is very likely that during vaginal births, the surgical count error rate is greater than the overall 10% to 15% error rate noted by The Joint Commission. Proposed Change To implement a highly reliable and standardized count process during all vaginal births that was more in line with structured counts of the perioperative suites. Implementation, Outcomes, and Evaluation Although limited, the literature demonstrated the need to first revise the facility wide count policy and specifically address the count process for vaginal births. Next, informal staff surveys indicated that the existing process lacked clear expectations, identified significant gaps in the process, and confirmed breaks in communication between nursing and provider staff. These surveys also revealed that the team approached the counts for vaginal births in a less formal manner than the surgical counts in the perioperative suite. Based on this information we implemented a standardized counting system that included a defined interdisciplinary communication requisite, streamlined the documentation, and provided global team education. Within 2 months of the completion of phase one training (hands on training) and the policy revision, the count sheet audits demonstrated greater than 95% adherence. After Phase 2 training, which included video demonstration and eLearning, greater than 98% adherence was demonstrated using 100% count sheet and random observed audits. In the 3rd and 4th month of observed audits, 100% adherence was noted, demonstrating normalization of the new process. Implications for Nursing Practice Primary outcomes included improved communication between health care providers and nurses, count diligence, and standardization of the count culture within the vaginal delivery room. In addition, the process change enhanced patient safety by minimizing the risk of the RSI in the vaginal delivery room. Finally, although not utilized in this process change, there is clearly a need to evaluate the effect of assistive safe count technology during vaginal births.