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Retained Surgical Sponge Improvement Plan Toolkit Retained surgical sponges cause serious harm and possibly death presenting a 	serious safety risk to any patient undergoing surgery. Unintentional retained sponges 	should 	NEVER occur. These articles reveal current best practice solutions 	which can be 	implemented to improve current counting practice in the operating room to include 	communication, collaboration, change, quality, safety improvement and leadership roles 	for nurses today. Cahn, J., & Wood, A. (2015). Affordable care act: turning reporting requirements into an effective strategy. AORN Journal, 101(2), 259-267. https://doi.org/10.1016/j.aorn.2014.11.005 This article discusses how the Affordable Care Act has placed many changes on healthcare today including changes for the quality of care provided instead of quantity. It shows how nurse leaders must examine the best way of providing high quality care and the need to manage and educate staff regarding the importance of quality reporting with a high safety culture. This resource is very important because reimbursements will not be made for services with safety violations such as falls, wrong site surgeries, hospital acquired infections, retained surgical items and medication errors. It is suggested that nurse leaders and administrators be proactive and analyze the data from the quality reports and make changes to policies to improve quality by prevention of future occurrences because it directly affects reimbursement. This resource is valuable for perioperative nurses and stresses the need to be current with quality care practices which every patient expects.

Davis, S. S. (2018). The key to safety: Communication. AORN, 108(1), 3-5. https://doi.org/10.1002/aorn.12298

This article depicts communication as a key factor for patient safety with any high functioning operating room team. It reveals that a culture of safety is vital, and it is important to speak up if a safety concern is noted. Examples are given for when a break in sterile technique is identified, and stresses the staff have a responsibility to speak up, however, some staff may not speak up because of fear of retribution or negative responses. This article stresses that nurses are advocates for patients and must speak up every time a safety risk is identified and explains how standardized communication tools should be used to relay critical information. Situation-Background-Assessment-Recommendation (SBAR) is one such communication tool. It is suggested that nurses benefit from effective and concise communication using the SBAR tool to relay information which is in a structured format. Additionally, all nurses, not just in the operating room, should feel comfortable and supported to speak up if there is an identified safety concern.

Fencl, J. L. (2016). Guideline implementation: Prevention of retained surgical items. AORN Journal, 104(1), 37-48. https://doi.org/10.1016/j.aorn.2016.05.005

This research article reveals that unintentionally retained surgical sponges are preventable, harmful to the patient and should never occur. It shows that a collaborative team approach is essential for prevention because there are many staff of different disciplines in the operating room. This resource may be beneficial for nurses because it highlights that during the counting process everyone should reduce noise, distractions and questions when counting is performed and additionally, should pursue methods that could improve current policies. Furthermore, the use of the technology, such as bar coding or radiofrequency wand, in concert with manual counting can lessen the occurrence of retained sponges. It is suggested that nurses should be knowledgeable of current best practices to care for our patients. Any nurse in the operating room or perioperative area would benefit from the enriching information in this article.

Garrett, J. (2016). Effective perioperative communication to enhance patient care. AORN Journal, 104(2), 111-120. https://doi.org/10.1016/j.aorn.2016.06.001 This article reflects that effective communication is part of a culture of safety, is vital for patient safety and a breakdown in communication is the primary cause of patient harm and even death. It shows how poor communication is the cause for over one third of all sentinel events reported to the Joint Commission. This resource may be valuable to nurses showing how collectively, as a team, effective communication is required to provide safe care. It is suggested that use of a variety of media available today be used to educate all nurses and healthcare providers about the need for effective communication skills including emails, texts, memos and internet beginning with leadership, distributed to all staff and flow back again to leadership ensuring communication reaches everyone. Any barriers to communication must be abolished by healthcare leaders to allow for effective communication. This resource is valuable for perioperative nurse leaders because it demonstrates the need to lead by example with effective communication skills. This resource can be used by all healthcare members, collectively as a team, to facilitate effective communication to improve the safety of every patient and suggests communication should be clear, concise and complete in a standardized format. ..

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002 This article reveals how change is necessary for ultimate growth and efficiency of an institution. Its shows Kurt Lewin’s model for change is an effective tool to change the status quo and lead to adaptation of new or desired institutional changes using a three-step process. It is suggested to unfreeze the old behavior, bring about changes for the new desired process and refreezing the new process. This resource proves beneficial to rid institutions of siloed or status quo processes and allows conditions for the development of more easily attained changes which is necessary for the dynamically changing field of healthcare today. This resource should be reviewed by nurse leaders who desire change in processes.

Spruce, L. (2015). Back to basics: Implementing evidence-based practice. AORN Journal, 101(1), 106-114.e4. https://doi.org/10.1016/j.aorn.2018.08.009

This article portrays that healthcare dynamics are changing to a more value motivated style and away from high volume of cases to high quality cases using evidence-based practices (EBP) to implement safe high-quality care. It suggests that nurses should always seek current EBP to reform the care provided and to understand the rationale for given policies to patients and other providers enabling them to put this into practice. This resource advises to review current policies at least every two years because healthcare evidence can rapidly change. It advocates for nurses to provide concrete data for why the care provided is changed by looking at improved patient outcomes based on EBP changes.

Spruce, L. (2016). Back to basics: Counting soft surgical goods. AORN Journal, 103(3), 297-303. https://doi.org/10.1016/j.aorn.2015.12.021

This article reports that sponges are the most common unintentionally item retained. It shows how a collaborative team approach to preventing retained sponges is necessary for prevention. All members of the team are accountable for preventing retained sponges and the safety of every patient. This resource may be helpful to the operative team as a reminder to collaboratively be aware when there is a change in the procedure or multiple procedures, multiple surgical teams, cases that run long, large blood loss or a large body mass index because there is a higher incidence of retained items. Teamwork is important because of human error and a culture of patient safety is paramount. It reveals that standard practices for manual counting should be augmented with technology to improve the correctness of the count. This resource suggests for all team members in the operating room to limit distractions, noises, interruption and questions when counting is performed which is vital because the safety of every patient requires a team approach. Every team member could benefit from a review of this article to ensure best practices are being followed.

Steelman, V. M., Schaapveld, A. G., Perkhounkava, Y., Storm, H. E., & Mathias, M. (2015). The hidden costs of reconciling surgical sponge counts. AORN Journal, 102(5), 498-506. https://doi.org/10.1016/j.aorn.2015.09.002 This article discusses the standard way of preventing an unintentionally retained sponge during surgical procedures is with manual counting and how retained sponges have only negative outcomes for patients, cause harm and even death. Anytime a sponge is missing or unaccounted for the staff must spend valuable time, up to ninety minutes, to locate it because the surgical case cannot continue and reported costs over $200,000 during this nine-month study. It is suggested that nurses review this article because most of the missing sponges were not located in the surgical wound, they distract from the given surgery and can increase surgery time. This data can be used by nurse leaders when doing cost analysis for discernment of adjunct therapies to manual counting.

Suratno, K., Ariyanti, S., & Kadar, K. S. (2018). The relationship between transformational leadership and quality of nursing work life in hospital. International Journal of Caring Sciences, 11(3), 1416-1422. Retrieved from https://www.capella.edu

This article for nurse leaders explains there are many roles for nurses today requiring a variety of leadership styles. It shows how transformational leadership enriches job satisfaction by empowering nurses and unites staff and leaders with like goals and institutional missions. When nurses are happy with their jobs because of high quality of care and a healthy work environment the retention rate is higher. This resource may be helpful for nurse leaders because it shows the importance of establishing trust and building professional relationships that empower the interdisciplinary team to increase confidence, responsibility and performance.

Lentini, A. (2017). Using technology in the OR to improve efficiency and patient care. AORN, 106(4), 7-14. https://doi.org/10.1016/S0001-2092(17)30841-4

This article explains how radiofrequency identification with inventory 	management in real time and how supply availability is perpetual and expiration dates/lot 	numbers can be easily seen. Additionally, it shows how this technology has been applied 	to sterile sponges used for surgeries as an adjunct to prevent retained sponges. A wand or 	mattress can be used to detect any retained sponge in the patient. This technology 	can 	help to detect sponges that are in the patient or on the sterile field. It is suggested that this 	option be explored by the operative and management to use in conjunction with manual 	counting to prevent retained sponges.

Wood, A. (2016). Clinical issues--January 2016: Clinical issues. AORN Journal, 103(1), 117-123. https://doi.org/10.1016/j.aorn.2015.10.020

This article stresses patient safety as the chief objective when caring for an operative patient. It shows some areas that could compromise patient safety and the importance of applying best practices when counting during operative procedures and this information could benefit operative nurses. White count boards are used to keep a running tally of sponges, soft goods, needles and miscellaneous items that are used during any surgical procedure. The article suggests the RN circulator write on the count board in a standardized manner which is easily visible by all on the operative team. Instrument are counted using the printed count sheets that come with the instruments. Is article points out that there is individual accountability but the team is collaboratively responsible for the prevention of any retained surgical item. It suggests that nothing should be subtracted from the board because of potential mistakes with mathematical computation and the same circulator 	and the scrub should perform the counts. This resource show be reviewed by operative nurses and makes known that these principles are great reminder for all members of the operating room teams.

Zomorodi, M., De Saxe Zerden, L., Alexander, L., & Nance-Floyd, B. (2017). engaging students in the development of an interprofessional population health management course. Nurse Educator, 42(1), 5-7. https://doi.org/ 10.1097/NNE.0000000000000298 This article presents the need for a collaborative team approach to improve 	the overall function of a team which results in increased safety, quality and overall 	efficiency. This resource may be useful for nurses to understand that teams learn 	about, from and with other professionals. It is suggested that this resource be 	reviewed when developing a team to work for the common goal of the institution 	because it is vital to the overall success of a collaborative team.