By Valerie Y. Marsh DNP, RN, CNOR

The modern hospital operating room is no place for technophobes or Luddites. Just as no doctor or nurse today would countenance the use of “medicinal” leeches to draw out the “bad blood” that physicians in medieval times thought caused many of their patients’ ailments, there is simply no good reason to rely solely on whiteboards to track the use of surgical sponges in the operating room.

Dr. Valerie Y. Marsh, RN, CNOR

Among medical professionals, the retention of surgical sponges has been dubbed a “never event” — meaning, it should never happen — but that would come as a shock to the estimated 10 to 12 patients daily in the U.S. who are wheeled back to their hospital rooms unwittingly carrying a surgical “souvenir.”

Far from being “never events,” retained surgical sponges remain a clear and present danger, what with thousands of surgeries being performed daily across the country. But as luck would have it, it’s a danger that easily could be avoided — along with the medical-malpractice lawsuits that follow.

Drawbacks of Traditional System
It is important to recognize and acknowledge the inherent shortcomings of the traditional manual method, where nurses use paper and pencil, whiteboards and dry-erase markers to account for the number of surgical sponges used in an operation. The paper and pencil method, although archaic, is still used in many institutions today. The whiteboard-and-marker method came into being in an age when it was the best technology available. It has proven to be a reliable method in the vast majority of surgeries.

Though nurses and surgical techs are loath to admit it, it’s far too easy to lose count of the number of sponges utilized in a surgery or to miscount the sponges as they’re removed at the end of a procedure. Surgery should never be performed assisted only by fallible personnel with just a whiteboard or paper and pencil. Technology can ensure that patients won’t be sewn up with a sponge left inside of them. High-tech devices are available to double-check an accurate sponge count.

Electronic Tracking
With one system, each sponge is assigned a unique bar code, not unlike those on grocery items. The sponges are scanned into a computer system, again similar to the way the supermarket checkout works, at the beginning and during the surgical procedure. At the end of the surgery, the sponges are scanned out, at which point any discrepancy in the count is flagged so that it can be rectified.

Such a system should be used to augment, rather than replace, the paper and pencil or whiteboard count. It gives nurses the confidence their manual tally is accurate. Think of it as a second line of defense — or, in medical parlance, a second opinion, if you will — providing a measure of confidence when the two counts match. The technology can protect the health and safety — perhaps even the life — of the patients and at the same time protect the surgeon and the hospital from medical-malpractice lawsuits.

For medical personnel, the priority should always be to provide patients with the best care to ensure, to the greatest extent possible, the best outcomes. As such, nurses need to remain open to the best available practices for doing so, even when those new methods require minor changes to OR procedures.

Best OR Practices
A typical argument against the technology is that if it’s anticipated that the procedure will only require 10 sponges, clinicians may ask, “Why bother?” It only takes one unaccounted-for sponge to create a problem. Furthermore, you seldom, if ever, know ahead of time how many sponges a given surgery is going to require.

In my five years’ experience as a perioperative education specialist where I train personnel in the use of this technology, I’ve seen a lot of such pushback. That is despite the fact that both the literature and professional organizations, including the Association for periOperative Registered Nurses (AORN), say technology like bar-coded sponges and a scanner are beneficial and could be used as a second line of defense to prevent retained surgical sponges.

Still, some perioperative care personnel felt it took too much time to use such technology. The literature does show that it takes a few seconds to scan sponges, but the benefits outweigh the additional time and costs associated with retained surgical sponges.

When the bar-coded sponges and scanner system was implemented in one such case, we surveyed the staff and found that many felt it took too much effort. As a result, they developed workarounds instead of following standard protocol consistently and correctly. They felt that the old process was good enough and had worked for the past 30-plus years. What they did not realize is that human error can and will happen during the counting process.

Therefore, data matrix technology is a great way to decrease the chance of human error by providing a second line of defense to protect the surgical client from the emotional journey of a retained surgical sponge related to human error. It’s what best for patients, and ultimately it’s what’s best for nurses and surgeons, too. The emotional impact of a retained surgical sponge not only affects the patient and the patient’s family, it also impacts the surgical team.

Process Improvement
USA Today relayed that thousands of patients annually suffer the consequences of a retained sponge. It is clear the old process is not working well enough — at least not on its own. Whatever small inconveniences come along with implementing technology that will drastically reduce, if not totally eliminate the threat, we have a responsibility to adapt and to ensure the technology is being used properly every time.

Retained-sponge prevention technology should be a standard protocol on every surgical procedure. Once staff are familiar with the technology and embrace it as another line of defense to keep our patients safe from harm and prevent this “never event” from happening, it will become second nature. It will effectively become the new “way we’ve always done it.”

–Valerie Y. Marsh is an adjunct clinical faculty at the University of Michigan.