The perioperative RN has a professional, ethical, and legal responsibility to prevent a retained foreign body (RFB). That responsibility is to account for those items which could possibly be retained. Prudence and common sense are required to ascertain if the surgical wound is such that surgical equipment could possibly be left behind and indicative of counting those items used within the sterile field (such as sponges).
The 'legal standard of practice' refers to what any prudent RN with similar training, experience, and education would do in the same or similar situation. Perioperative performance will be evaluated in relation to the Association of periOperative Registered Nurses Standards and Recommended Practices (RP) in a court of law. Performance failing to demonstrate this standard may be considered negligence.1 A RFB is seen as 'prima facie' evidence of negligence. Meaning the retained items should have been prevented. The clinical judgment of such a situation is left to the professional involved in the surgical procedure and must be in compliance with the policy and procedure of their employer.
So how do RFBs occur?
Human error, lapses, or deviation from the standardized process or failure to perform a surgical count are primary cause of RFBs. The incidence of RFB has been reported as between 1 in 8801 to 1 in 18,760 surgical procedures, or one or more per year for a large facility.2
Given what we know about human error and risk factors, what can we do to avoid RFBs? Some suggestions include: reviewing the surgical plan of care; decreasing staff turn-over during the case, especially in the scrub role; standardization of the process and instrumentation; and decreasing interruptions, distractions and competing tasks.
Other methods of reducing the risk of a RFB are:
1. Review and revise your policy and procedure to reflect current AORN RP and emerging technology.
2. Ensure the staff has a clear understanding of who, what, when, and how to perform the surgical count.
3. Educate and then follow up with direct observation of the counting process for accuracy, compliance, and practicality.
4. Effective communication; 43% of adverse events in surgery are due to break down in or lack of communication.2
5. Continual evaluation of emerging technology for scanning patients, items, and the surgical wound for retained items.
One study reported problems in communication, information flow, workload, and competing tasks as having a negative impact on the ability to perform a surgical count correctly.3 Incorporating an intentional pause during closure to allow a focused count is prudent and in the best interest of all involved.
We have a professional, legal and ethical obligation not to harm our patients. We share a professional obligation to learn and evolve through conscious, deliberate action.
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