Surgical count practice variability and the potential for retained surgical items.

Validating existing count practices and reducing individual practice variance are necessary to decrease the risk for retained surgical items. A quality improvement project was undertaken at one large city hospital to identify best practice and eliminate variability in count practices. The project included an analysis of 20 surgical count policies from hospitals across the country and a review of count practices among nurses and surgical technologists at the facility. Assessment of the policies and practices indicated that clinical practice requirements in the policies varied greatly, and there was a high degree of count practice variability among staff members. The facility OR manager and OR quality coordinator collaborated with staff nurses and surgical technologists to identify practices that created variability and then addressed each one to create a new count policy and reduce the risk of retained surgical items.