The document discusses surgical counting procedures and retained surgical items (RSIs). It provides guidelines for counting accountable items at different stages of a surgical procedure, including an initial count before the procedure, additional counts before closing cavities, and a final count at the end. It emphasizes the importance of counting to ensure all items are removed and reduce risks of injury. For laparoscopic surgeries specifically, it recommends partial counts where only used instruments are counted rather than all instruments. A study found the partial count method increased counting efficiency by 44-70% compared to full counts. Stakeholder feedback found the partial count method was effective, efficient and improved communication between surgeons and nurses.
Surgical instrumentation is critical to surgical procedure.
The performance of OR team is enhance when team members know each instrument by name, know how each is safely handled and know how each is used.
Preparing the instrument for appropriate processing will prolong its use in patient care and decrease the costs for repair and replacement.
The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.
ORPs Educational Programme
Admin & Fascinator (Moule #01-Asepsis & Infection Control for the month of February-2013) • Karachi, Pakistan
1.Education for all ORPs
2.Produce Educated ORPs.
3.Teach & Training about all Surgical Technique & Skill
4.Conduct 2 seminars in each month at different Venue
5.Join All ORPs to Apply registration through
* sms * E-Mail *Facebook * Skype * other relationship
• ORPs Education
Apr 13, 2013 to present
COURSE OUTLINE :
*Module #1 (Operating Room)
*Medical Terminologies
*Feature of Surgical Equipment
Surgical instrumentation is critical to surgical procedure.
The performance of OR team is enhance when team members know each instrument by name, know how each is safely handled and know how each is used.
Preparing the instrument for appropriate processing will prolong its use in patient care and decrease the costs for repair and replacement.
The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.
ORPs Educational Programme
Admin & Fascinator (Moule #01-Asepsis & Infection Control for the month of February-2013) • Karachi, Pakistan
1.Education for all ORPs
2.Produce Educated ORPs.
3.Teach & Training about all Surgical Technique & Skill
4.Conduct 2 seminars in each month at different Venue
5.Join All ORPs to Apply registration through
* sms * E-Mail *Facebook * Skype * other relationship
• ORPs Education
Apr 13, 2013 to present
COURSE OUTLINE :
*Module #1 (Operating Room)
*Medical Terminologies
*Feature of Surgical Equipment
Surgical instruments are incredibly important for hospitals around the country. They represent a significant investment hospitals make to take care of their patients. As such, they must always be maintained in good working order. Better care and maintenance leads to better patient care as well as cost savings by increasing the tools’ lifespan.
the ot nursing is an essential concept that every student nurse must have an adequate knowledge in order to counteract the issues related to OT nursing.
Gowning and gloving technique Presented By Mohammed Haroon Rashid At Florence...Haroon Rashid
This Topic presented by Mohammed Haroon Rashid From Basic B.Sc Nursing Final Year students in Florence College of nursing Limtara dhamtari. This topic presented on workshop on the date 13 sep 2019.
This presentation was prepared by RUTAYISIRE François Xavier and ISHIMWE Diane, Medical students in Year 4(Doctorate 2) at University of RWANDA school of medicine and Pharmacy, Department of Medicine and Surgery. we did the work under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA
The World Health Organisation is a global tool to ensure safety in surgery. The principles and procedures are described for how to implement it in your organisation.
Surgical instruments are incredibly important for hospitals around the country. They represent a significant investment hospitals make to take care of their patients. As such, they must always be maintained in good working order. Better care and maintenance leads to better patient care as well as cost savings by increasing the tools’ lifespan.
the ot nursing is an essential concept that every student nurse must have an adequate knowledge in order to counteract the issues related to OT nursing.
Gowning and gloving technique Presented By Mohammed Haroon Rashid At Florence...Haroon Rashid
This Topic presented by Mohammed Haroon Rashid From Basic B.Sc Nursing Final Year students in Florence College of nursing Limtara dhamtari. This topic presented on workshop on the date 13 sep 2019.
This presentation was prepared by RUTAYISIRE François Xavier and ISHIMWE Diane, Medical students in Year 4(Doctorate 2) at University of RWANDA school of medicine and Pharmacy, Department of Medicine and Surgery. we did the work under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA
The World Health Organisation is a global tool to ensure safety in surgery. The principles and procedures are described for how to implement it in your organisation.
by - dr. sheetal kapse, 2nd year p.g. student, dept. of oral & maxillofacial surgery, RCDSR, Bhilai, C.G. please contact for any question...email id - sheetal.kpse@yahoo.com
- Minimally invasive technique
- Feasible & reproducible
- Single approach to a complete correction of the 3 compartments of the pelvic floor
- Excellent functional & anatomical results
- Limited risk of complications and good long-term results in the treatment of all types of POP.
- Shorter learning curve than conventional laparoscopy
This presentation was done by RUTAYISIRE François Xavier and ISHIMWE Diane, medical students at University of RWANDA School of Medicine and pharmacy, department of medicine and surgery. They did it while they were in Year 4 (Doctorate2), under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA. It tell us about what a surgical safety checklist is, and why is it important in surgical field.
Epidural dislodgements Audit Al Razi hospital KuwaitFarah Jafri
This is an audit I had done as Coordinator of acute pain service at Al Razi Hospital Kuwait. Through this I was able to draw attention to the rising rate of dislodgement and the technique of fixation was changed.
A Prospective Study of Evaluation of Operative Duration as a Predictor of Mortality in Pediatric Emergency Surgery: Concept of 100 Minutes Laparotomy in Resource-limited Setting
Artificial intelligence or AI in short is the latest technology on which the whole world is working today. We at myassignmenthelp.net are providing help with all the assignments and projects. So when ever you need help with any work related to AI feel free to get in touch
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Myassignmenthelp.net has a team of experts competent to handle all kinds of computer network assignments and homework. We are capable of handling all kinds of homework and assignments. Our team of dedicated experts has a rich experience of working with top-tier software firms across the world and understand all the aspects of a programming language http://www.myassignmenthelp.net/programming-assignment-help.php
ActionScript is a object oriented scripting language. Like ECMAScript the Actionscript is similar to the java script. Actionscript provides the interactive functionalitry to the the web site. Actionscript is mostly used in the flash software developer can set and control the actions of the Flash objects. Actionscript provide the additional features to the animation with flash and to create advance interactive animations and applications for the users. Actionscript is used for the kids tutorials and games so that kids can understand the lessons more easily. This is used by many advertisement companies to create the advertisements banners with flash and small animations http://www.myassignmenthelp.net/programming-assignment-help.php
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Nursing ppt by myassignmenthelp.net
1.
2. Surgical Counting
Counting for all accountable items throughout the
operative procedure(s) includes :-
1) Before the procedure to establish a baseline
(#Initial Count)
2) Prior to closure of a cavity within a cavity
(#Additional Count)
3) Before wound closure begins (#First Count)
4) At skin closure or at the end of the operative
procedure(s) (# Final Count)
5) At the relief of the scrub person (# Relief Count)
3. Purpose of Surgical
Counting
To ensure all items used during surgical
procedure are removed
Reduce the risk of injury (ACORN,
2006)
Gold standard to manage this risk
(Gibbs, 2003)
Responsibility of peri-operative RN in
charge of the case
4. Major items required to be
counted
Absorbent Items Sharps
Vascular Items
Disposable Retraction
Instruments
Major countable
Items
5.
6. Sentinel Event
Unexpected
Occurrence
• Death
• Physical
Injury
• Psychological
Injury
Loss of
Limb
• Loss of
function
• Risk thereof
• Immediate
investigation
required
Focus on
RSI
• Retained
surgical
instrument
7.
8. HOSPITAL AUTHORITY (HS)
Statutory Body under Hospital Authority
Ordinance
Manage Hong Kong’s Public Hospitals
Accountable to Hong Kong Special
administrative
Region Government
Contribute to fulfillment of Hong Kong SAR
Government’s policy
11. Siteof RSIs
37%
Abdomen
Extreme
Tonsillar bed
Eye
Thoracic
Oesophagus
Other
Quantity
(Counting)
11
Type of RSIs
63%
Tiny dislodged
fragment or broken
part
Raytec gauze &
Abdominal pad
Malleable
retractors
Contributing factor of RSIs
68%
Quality
(Integrity)
http://www.ha.org.hk/riskalert
12. RSIs in
Open Surgery
40%
Open Abdominal
Surgery
Open Other Surgery
RSIs in
Minimally Invasive Surgery
67%
Laparoscopic
Surgery
Endoscopic Surgery
67%
Raytec gauze or
abdominal pad
Malleable retractors
100%
Tiny disloged
fragment or broken
part
13. Complications due to RSI
Perforation of bowel
Sepsis
Loss of Limb or function
Death
14.
15.
16. A segment of plastic insulated sheath of a
laparoscopic instrument was retained inside
2008
Gyn. Lap. surgery
Plastic insulated sheath of a lap. forceps
Abdomen
HA Risk Alert, Issue 4 (2008)
patient
16
17. Contributing Factors
Difficult specimen retrieval
• Peeling off a piece of instrument
coating
Improper integrity of instruments
• No proper checking of instruments
before the end of operation
18. Recommendations
Non Insulated metal
• Instrument can be used with non
insulated metal outer tube for
specimen retrieval
Ensure integrity of instrument
• Instruments should be checked for
their integrity before the end of
operation
19.
20. An oval shaped metallic clamp button
from stapler was retained in patient’s
abdomen
20
2008
Lap. resection of rectum
Metallic clamp button from the stapler
Abdomen
HA Risk Alert, Issue 7 (2008)
21.
22. Grasping forceps was left in abdomen of
patient
22
2009
Metal plate inside the lumen of the forceps
Abdomen
23.
24. A metallic covering defect at the end of the
70 degree telescope was found
24
A fragment of the end of telescope
25. Details
Contributing Factors:
Difficulty in detecting
defect of delicate
instruments.
Low awareness of
staff on checking
instruments integrity.
Recommendations:
Use LED H and
Magnifier for
facilitating checking
and inspection of
instrument integrity
To document details
of scopes sued in
surgical operations.
26. Causative factors to RSIs
26
Cause-effect diagram
RSIs
Lap. surgery
Organization Method/Process Instrument
Work Environment Staff Patient Communication
Scrub person
-Distraction by
surgeon
-lack of awareness
on integrity of
Instruments
-Plenty of
instruments for
counting
-Spare parts/
screws
easily dislodged
-Long
operation
time
-Obesity
Scrub person- surgeon:
No confirmation of
correct counting
before closure
Scrub person-circulating
nurse:
No consistent sequence
in counting
Low compliance
on SAG standards
of checking
the instruments’
integrity when
closure of wound
No structured
policies to reduce
the risk of RSI
-Hasty environment
- Inadequate time for
checking the integrity
of instruments when
closure of cavity &
wound
27.
28. The swab and instrument count is essential
and plays key role in enhancing surgical
patient’s safety (Woodhead and Fudge,
2010).
Greenberg (2008) concluded that one in
eight surgical cases involves an intra-operative
discrepancy
Instruments can be retained during
laparoscopic procedures, therefore, initial
instrument counts should be performed
(AfPP 2007, AORN 2010, ACORN 2006,
SAG 2010, AST 2006)
29.
30. First P:
Practical utilization of laparoscopic instruments
30
Revised
G104-01
General & Team
B
Lap. Surgery
Revised
G104-02
Team D & U
Lap.
Surgery
Created
G104-03
Team A
Lap.
Surgery
↓ 3% ↓17% ↓47%
31. Second P:
Practical utilization of laparoscopic
instruments
31
Supplementary laparoscopic instrument
Screws
Screw x 2
Screw x 1
Screw x 2
Metal Ball (左
右) x 2
鍋釘(左右) x
2
螺絲帽x
1
32. Third P:
Partition of Used & Unused
laparoscopic instruments
32
Separating
Additional instrument tray
33. Fourth P:
“Partial Count” in Laparoscopic surgery
Initial counts 1st
Closing count
2nd
Closing
count
3rd
Closing
count
Before sending
to CSSD
Relief count
AfPP (2007) UK / Nurses
AORN (2010) USA / Nurses
ACORN (2006) Australia/ Nurses
ACS (2005) USA / Surgeons
SAG (2010) HK / Nurses
AST (2006) USA / Technologists
Before the
procedure
Before closure
of a cavity
within a cavity
Before
wound
closure
begins
At skin
closure or
end of
procedure
At the time of
permanent relief of
either the scrub
person or circulator
Laparoscopic surgery After all trocars removed
(Closure of peritoneum, muscle layer, and fascia
en masse in laparoscopic surgery)
Absorbent items Yes Yes Yes
Sharps & Other miscellaneous
items
Yes Yes Yes
Basic
instruments
Yes No Yes Yes
Laparoscopic
instruments
ALL
Laparoscopic
instrument
Used
Laparoscopic instrument
ALL Laparoscopic
instrument
ALL
Laparoscopic
instrument
Counted &
a visual
inspection for
completeness
A visual inspection for completeness Counted &
a visual
inspection for
completeness
Counted & a visual
inspection for
completeness
33
34.
35. Prescriptive nature of procedure
Lack of clarity what constitutes an
‘accountable’ item
Failure to consider current technologies
and use of plastics and other X-ray
detectable items (Hamlin, 2005)
36.
37. Pilot study
Phase 1
15 Elective
Laparoscopic
Colorectal Surgery
5
patients excluded
2 patient
convented to open
surgery
3 patients' scrub
persons were not
trained
10
patients included
Phase 2
5 Elective
Laparoscopic
Urological Surgery
4
patients included
1
patients excluded
1 patient
convented to open
surgery
37
40. 40
Full count – Partial count
4’30”
2’32”
300
250
200
150
100
50
0
Full Count (N=10) Partial Count (N=14)
Time (Seconds)
Efficiency: ↑44%
41. 41
Number of Used Lap. instruments
2’44”
1’18”
180
160
140
120
100
80
60
40
20
0
More than 12 (n=12) Fewer than or equal to 12 (n=2)
Time (Seconds)
Efficiency: ↑52%
50. Future Development
Standard
Operating
Procedure
(SOP)
Guideline for all
laparoscopic
procedures
Guidelines for
Specialty Nursing
Services
(Perioperative
Care)
50
Editor's Notes
Specialty guidelines in Peri-operative Care, 2010 (SAG in Peri-op/Ana, HAHO)
Standard No 2.9 “ Counting of Accountable Items used during Operative Procedure (s)”
# Illustrated definition from a generic count sheet in Peri-operative care by SAG in Peri-op/Ana, HAHO, 2013 indicates
Check all accountable items for entirely throughout procedure(s). Checking should include i) Integrity of all accountable items; ii) Completeness of any broken or cut item
Instruments recorded on the tray list
Absorbent items, including sponges, swabs, patties, cherries, peanuts, eye swabs (strolls), gauze strips, cotton wool ball and skin preparation swabs
Sharps, including needles, detachable blades, disposable scalpels and diathermy tips
Vascular items, comprising vessel loops, snuggers, cardiac snares, tapes, ligature reels, ligaboots, slip cartridges and disposable bulldog clips
Disposable retraction instruments
Any additional items opened during the procedure
Sentinel Events are known to be the ones that results in some unexpected occurrence leading to some kind of serious physical or psychological injury and can even lead to death of the patient.
These events may also result in loss of limb or functioning of any body part of the patient and calls for immediate investigation and response in case of reporting by the patient.
In the current presentation, we will focus on the incidence of retained surgical instruments which is a major cause of sentinel events in most of the cases.
In the current presentation we have presented some key cases for study which have been taken from the publications of Hospital Authority (HS). These cases will help us in getting a detailed idea of what exactly is RSI and what can be the consequences of such incidence. Also, the learnings available from each of these case will help us in getting the knowledge about the course of action to be followed in order to avoid the cases of RSI especially in Laparoscopic surgeries.
Source:
Risk Alert, Issue 29 (2013)
http://www.ha.org.hk/riskalert
The above statistics shows the frequency of sentinel events from the year 2007 to 2013. A total of 80 cases were considered out of which it is clear that there were 32 cases reported of RSI in operation theater which is 40% of the total cases considered and rest RSI cases were reported from other departments.
Source:
http://www.ha.org.hk/riskalert
The above charts shows the frequency of RSI incidence in surgeries associated with various body parts and it is clear that most of the cases have been reported that of surgical instruments retained in abdomen of patients.
Then the frequency of contributing factors have been shown clarifying that lack of checking the integrity of instruments have remained the major cause of such RSI incidences.
Additionally, we can see that tiny dislodged fragmented or broken parts have remained the major type of RSI in most of the cases.
Source:
http://www.ha.org.hk/riskalert
From the above charts we can see that in case of open surgeries 40% have been that of abdominal surgeries reporting RSI and have reported that raytec gauze or abdominal pad was retained inside the patient’s body.
It has been reported that one of the major contributing factor to the incidence was peeling off a piece of the specimen instrument
Another contributing factor was that proper emphasis was not placed in thorough checking of instruments used in oeprations for their integrity before the end of the oepration.
Recommendations
Observe the integrity of device before and after use
Use safety designed surgical device and consumables
Develop device tracing system
Recommendations:
Alertness on the integrity of the equipment during an operation
Source:
Recommended Practices for Prevention of Retained Surgical Items (2011)
Source:
HA Risk Alert, Issue 27 (2012)
The present slide provides a detailed report on various causative factors to RSI. In case of laparoscopic surgeries there are some key factors related with workplace environment, attitude of staff, patient and communication that can result in various instances of RSI.
Apart from above justification, there may be instances in which instrument counts may be waived (AORN 2010).
Standard statement 2 cited on S3” Counting of Accountable items Used during surgery” by ACORN (2010) state “HCF shall develop a policy which clearly defines the counting process within their organization and is used in conjunction with the standard”
In laparoscopic surgery, multiple instruments are opened. Counting and tracking them all is time consuming and probably error prone, so the hospital has developed exceptions to the general requirement of counting all instruments. Exceptions have been made based on the size of the instrument in relation to the wound (Gibbs 2011).
Rationale of ACRON:
ACORN acknowledges that each surgical procedure carries a different risk for instrument or other items being retained.
Revise content list of lap. Instrument tray and streamline the uncommonly used items.
Liaison with surgical and ORIS team leaders to revise the instrument list and become more practical.
The objective of these strategies are to:
To standardize count procedure in Laparoscopic Surgery
To promote a “Collaborative Practice” culture
Use of a separating tray for used and unused laparoscopic instruments will help in counting in a precise and effective way
Association for Perioperative Practice (2007)
Association of peri-Operative Registered Nurses (2010)
Australian College of Operating Room Nurses and Association of peri-Operative Registered Nurses (2006)
American College of Surgeons (2005)
Specialty Advisory Group – Peri-operative (2010)
Association of Surgical Technologists (2006)
Before closure of peritoneum, muscle layer, and fascia en mass
Source:
Recommended Practices for Prevention of Retained Surgical Items (2011)
A Pilot study was conducted under two phases: Phase 1 and Phase 2.
Under Phase 1 15 elective laparoscopic colorectral surgeries were considered where 5 patients were excluded while 10 were included. It was found that 2 patients of the excluded five were converted to open surgey and rest 3 were scrub patients and thus were excluded from the study.
In Phase 2 5 Elective laparoscopic urological surgery cases were considered out of which 4 patients were included while one was excluded because he was converted to open surgery.