A refresher on surgical sponge accounting created by Cristina Martinez

1. Sponge Accounting
July 2016
SPONGE ACCOUNTING: PREVENTION OF RETAINED SURGICAL ITEMS
Policy #AD-PC 197

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• All sponges
– E.g. laps, baby laps, raytex, tonsil sponges, peanuts, cottonoids,
radiopaque towels.
• All sharps
– Suture needles, scalpel blades, hypodermic needles.
• Misc
– Bovie tips, vessel loops, umbilical tapes, suture booties, or capio.
• All Instruments
– On all abdominal & thoracic procedures.
What to Count?

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What to Count?

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Counts will be taken in the following sequence:
1) Surgical site
2) Sterile field
3) Mayo stand
4) Back table
5) Kick buckets
6) Sponge Holders
Count Sequence

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• In Count
• Initial baseline count.
• Cavity Count
• Count performed before closure of cavity within a cavity (e.g. uterus, bladder,
stomach, peritoneum.
• Closing Count
• Count performed before fascial wound closure begins.
• Relief Count
• Count performed at time of permanent relief of either surgical tech or circulating
nurse.
• Final Count
• Count performed after skin closure, when surgical items are no longer in use and all
are passed off the field. THE FINAL COUNT IS A VISUAL OF ALL SPONGES ACCOUNTED
FOR in blue backed sponge holders.
When to Count?

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Incorrect & Miscounts
What to do when your counts are off.

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• An Incorrect Count is a count that
does NOT get reconciled.
What is an Incorrect Count? And what do you do?
• Inform your charge nurse and
follow your chain of command.
• Repeat Count
• Conduct a thorough search of
the room.
– Sterile trash, dirty trash, linens &
floors
• Call for x-ray if needed.
• Document count results &
actions taken.
– Incident Report
– Incorrect Count Form
– ORM Documentation

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• A Miscount is a form of an
incorrect count but the major
difference is that a miscount is an
incorrect count that gets
RECONCILED.
What is an Miscount? And what do you do?
• Inform your charge nurse and
follow your chain of command.
• Repeat Count
• Conduct a thorough search of
the room.
– Sterile trash, dirty trash, linens &
floors.
• Call for x-ray if needed.
• Document count results &
actions taken.
– Incident Report
– Miscount Form
– ORM Documentation

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What can we do to
Protect the Patient?

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• Learn and follow facility’s Sponge Accounting Policy and
Procedures.
• Promptly report any incorrect count.
• Utilize chain of command if necessary.
– Charge Nurse, Manager, Director
• Document accurately and thoroughly.
• Fill out an Incident Report.
• Fill out appropriate forms: Miscount and Incorrect Count forms in Core
and Front Desk.
• Document in the ORM appropriately with counts, xrays, and staff
involved.
Take Responsibility!

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• CODI/Policy & Procedures
• Posters by Dry Erase Boards
• Resource Staff
• Charge Nurse
• Educator
• Staff Lounge
• Policy on tables
• Morning Meeting Minutes Log
Resources

12. Thank You