New York Presbyterian Hospital, New York, New York
J Dr Nurs Pract. 2021 Nov 1;14(3):213-224. doi: 10.1891/JDNP-D-20-00045.
In the main operating rooms of a large academic hospital there was a report of 408 count discrepancies in 2015-2016 and 13 incidences of retained surgical items (RSIs). There was a lack of a consistent and standardized surgical count process among nurses.
To reduce count discrepancies by 25%, prevent RSIs, and improve the compliance of the perioperative nursing team regarding the surgical count process.
An evidence-based quality improvement project with a sample of 455 surgical procedures and 118 nurses. Data collection occurred over an eight-week period in 2018 using a Plan-Do-Study-Act (PDSA) methodology to study the effectiveness of the utilization of the Association of periOperative Registered Nurses (AORN) practice guidelines for the prevention of RSIs.
The inclusion of risk reduction strategies such as the utilization of an AORN guideline whiteboard to record surgical items and the identification of high-risk items for retained device fragments or high-risk surgical items for RSIs resulted in the reduction of incorrect surgical counts by 71.43%, with no incidence of RSIs. Further, nurse compliance on surgical count practices improved significantly, F (5, 46) = 2.47, p = .046, PES = .21.
The implementation of the AORN guidelines for perioperative surgical count practices by the perioperative nursing team provided an improved surgical count process.
A system approach to performance improvement is needed to prevent RSIs.
在一家大型学术医院的主要手术室中，报告称在 2015-2016 年期间出现了 408 次计数差异，并有 13 起遗留手术器械（RSI）事件。护士之间缺乏一致和标准化的手术计数流程。
将计数差异减少 25%，防止 RSI，并提高围手术期护理团队在手术计数流程方面的合规性。
这是一项基于证据的质量改进项目，样本量为 455 例手术和 118 名护士。2018 年，采用计划-实施-研究-行动（PDSA）方法进行了为期八周的数据收集，以研究利用美国围手术期注册护士协会（AORN）预防 RSI 的实践指南对预防 RSI 的有效性。
包括风险降低策略，例如利用 AORN 指南白板记录手术器械以及确定高风险器械碎片或高风险 RSI 手术器械的项目，从而将不正确的手术计数减少了 71.43%，且未发生 RSI 事件。此外，护士在手术计数实践方面的合规性显著提高，F（5,46）=2.47，p=0.046，PES=0.21。
围手术期护理团队实施 AORN 围手术期手术计数实践指南提供了改进的手术计数流程。
需要采用系统方法进行绩效改进以预防 RSI。
