The common sentinel events in surgery involve the wrong site, patient, and procedure errors. In this article, nurse practitioner Rebekah Price discusses the standard of care for preventing surgical…
The most common preventable injuries to patients during surgery involve small sponges, clamps, and other objects left inside the body cavity. In this article, nurse practitioner Rebekah Price discusses the standard of care for preventing retained objects in the operating room.
Virtually any object that has contact with a patient’s body during an operation has the potential to be left inside the patient, causing severe harm. The medical phrase URFO (Unintended Retention of Foreign Objects) or RSI (Retained Surgical Items) describes a foreign object retained inside a patient’s body following surgical procedures.
URFO and RSI are known as “never events,” severe medical errors or incidents that should not occur to a patient if proper safety procedures are followed. The health care industry has established specific safety measures to protect patients in high-risk areas, like the operating room.
The forensic investigation of these incidents will frequently focus on establishing the causative breakdown that resulted in foreign object retention. With a thorough examination of surgical room policies and procedure(s), health care experts specializing in surgical nursing can reliably examine factors relevant to liability.
There are many risk factors for URFO and RSI, including:
The Joint Commission, the global driver of patient safety, has identified the most common surgical errors that lead to URFOs. Among these errors are:
Objects left inside the body cavity can include needles, scalpels, drain tips, sponges, towels, forceps, scopes, guide wires, scissors, gloves, tubes, and surgical masks. If foreign objects are left inside the body for an extended period, scar tissue can develop, requiring additional surgeries that are both medically risky and financially burdensome for the patient and family. Additional complications can result in pain, infection, sepsis, internal bleeding, digestive issues, permanent disability, and death.
Most hospitals and facilities use counting procedures to prevent URFO. These guidelines, developed by the American College of Surgeons (ACS), the Association of Perioperative Registered Nurses (AORN), and the Joint Commission, recommend counting all sponges, sharps, and instruments at specified times. However, what remains to be seen are specific directives on how, who, and when these counts should be completed.
“NoThing Left Behind” is a national surgical patient safety project developed in 2004 by Dr. Verna Gibbs to assist health care stakeholders in mitigating risk and improving the antiquated simple counting process. This project aimed to improve accountability procedures, such as requiring two people to participate in each sponge count, physically separating sponges as they are counted aloud, pausing to count objects, and visually inspecting the patient before closing any body cavity.
Despite these recommended directives, continued research since the safety project began indicates that URFO cases still show misreporting and miscounting discrepancies. Research also reveals that sponges are the objects that are most likely to be left behind.
These sponges have become the primary target for improvement and risk prevention, as advancements like barcode, chip, and radiofrequency detection technologies in every sponge (confirmed by radiology) aim to improve the manual count process. Regardless of advancements, this counting process depends on human performance in a stressful and complex medical environment. These risk reduction strategies and assistive technologies are not foolproof when considering the human factor and the potential for error.
The experts at Robson Forensic are qualified to investigate a broad range of issues relevant to surgical incidents, including preoperative, intraoperative, and postoperative phases of patient care.
For more information, submit an inquiry or call us at 800.813.6736.
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