AL KHAFJI NATIONAL
HOSPITAL
Use of Reliable System
and Devices For The
Surgical Count Process
MISTAKE PROOFING THE KNH
OPERATING ROOM
05/07/2025
BACKGROUND
The surgical count process stands out among the practices advocated
by the World Health Organization to ensure surgical safety. The literature
indicates that this practice should be performed in all surgical processes.
However, surgical items are still retained.
Unintentionally retained surgical items (RSI) are a global problem
contributing to adverse events for surgical patients. The Association of
perioperative. Registered Nurses (AORN) has developed a standardised
protocol for the surgical count; however, many hospitals do not follow the
protocol for the surgical count. This study was conducted to investigate the
effect of implementing quality improvement interventions, for counting
surgical sponges, on compliance with the AORN surgical count protocol and
occurrence of count discrepancies.
05/07/2025
“Our Best
STATEMENT OF THE PURPOSE
Recommended practices provide guidance to perioperative nurses in performing
sponge, sharp and instrument count in the practice settings. Counts are performed to account
for all items and to lessen potential injury to the patient as a result of a retained foreign body.
Complete and counting procedures help promote optimal perioperative patient outcomes and
demonstrate the perioperative practitioners commitment to patient safety. The doctrine of Res
ipsa loquitor (ie, the thig speak for itself) is most applicable in cases involving retained objects,
rendering those litigations nearly indefensible. Retained objects are considered a preventable
occurrence, and careful counting and documentation can significantly reduce, if not eliminate,
these incidents.
In the conduct of surgical procedures, it is essential that all of the sponges and similar
items, used in the procedure, are accounted for before the procedure is completed. However,
because of the very difficult conditions that often exist during the procedure, the current
accounting systems are not always effective.
It is, therefore, an outstanding object of some embodiments of the present invention to
provide a rack for surgical sponge counter bags that provides an simple, efficient, and
very reliable method for accounting for the surgical sponges, and surgical squares.
05/07/2025
“Our Best
PICO QUESTIONS
PICO Population/Patient/Problem INTERVENTION COMPARISON OUTCOME
How would I describe the problem or a What main intervention, Is there an alternative to What do I hope to accomplish, measure,
Guide Question group of patients similar to mine? prognostic factor or exposure compare with the intervention? improve or affect?
am I considering?
Implementation of Surgical Sentinel events related to
Sponge Counter Use VS Use of Surgical Traditional Sponge
miscounting of sponges will
the Traditional Sponge Sponge Counter Counting
be totally prevented
Counting in an Operation
05/07/2025
“Our Best
Root cause Analysis conducted by
Abella (2019)
05/07/2025
05/07/2025
SUMMARY OF FINDINGS
In summary:
1. Sponge Counter Bags Provides easy sponge counting and containment.
2. Excellent visibility for counting sponges and reduces body fluid contact.
3. Accurate measurement for assessing absorbed fluid.
4. Meets AORN recommended practices. More efficient better organized one
pocket one sponge method of counting.
5. Allow continuous sponge counting and containment to minimize exposure to
blood borne pathogens.
6. Clear polyethylene pockets allow sponges to be viewed for visual estimate of
patient blood loss. Available with seal to contain sponges for safe disposal.
05/07/2025
“Our Best
RECOMMENDATIONS
The implementation of sponge rack counter (quality improvement interventions),
including training in count protocol and using counter bags and count sheets, is
recommended to improve the counting performance of perioperative nurses and
reduce the incidence of count discrepancies and incorrect counts.
This study found that implementing quality improvement interventions increased
compliance with the AORN protocol for counting surgical sponges, improved the
quality of the counting process and significantly reduced surgical sponge count
discrepancies.
Therefore, the implementation of quality improvement interventions, including
training in and use of sponge counter bags and surgical sponge count sheets and
training in standardised surgical count protocol, are recommended to improve the
counting performance of perioperative nurses and reduce count discrepancies,
incorrect counts, the duration of surgery and frequency of RSI events.
05/07/2025
“Our Best
IMPLICATION OF THE EVIDENCE
Researched suggest that technology may have a greater capacity to answer the
question, “where are the sponges”, by showing and viewing the sponges before
closure of operative site, thus making sure that ni sponges unintentionally left
inside the patient.
The implementation of quality improvement interventions, including training in
count protocol and using counter bags and count sheets, is recommended to
improve the counting performance of perioperative nurses and reduce the
incidence of count discrepancies and incorrect counts.
05/07/2025
“Our Best
Sentinel events related to miscounting of
sponges will be totally prevented
Allows continuous sponge counting and
containment to minimize exposure to blood borne Provide a visual control as nurses can
pathogens easily determine the sponges
accounted
Surpassing the accuracy of the
manual surgical count Prevents unreimbursed surgery
and prevent surgical delays
Improves the trust between the
surgeon and the nurses
count
Decrease the span of time utilized during
sponges, instruments and needles count
Prevent extra cost from the hospital due to
extended hospitalization of patient
Increase efficiency of determining the
number of used surgical sponge
05/07/2025
“Our Best
MEASUREMENT
Room Turnover Time or OR Turnaround Time
RSB Rate (Retained Surgical Bodies)
05/07/2025
“Our Best
05/07/2025
