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Prevention of Retained Sponges during surgeries: A retained sponge should never occur. Best-practices will be explored. Current policies should be revised to safeguard our patients from retained sponges and provide the best care possible.

Incidence Any retained sponge is too many. It is estimated that between every 1000-19,00 procedures results in a retained surgical item. The goal being to prevent any unintentional retention of a surgical item.

Outcomes: Prolonged length of stay Increased misery and pain Reoperation Readmission Infections or sepsis Permanent disability Death

The operative team should always STOP to CONSIDER when a patient is considered at a higher risk for retained sponge

Consider: Is there is an unexpected change in the procedure Multiple surgical teams Emergency surgeries where no count is performed Long case times Large blood loss Large body mass index

Current Practice for Counting: Audible and visual manual counting For all surgical procedures for instruments, soft good and radiopaque sponges before start time When items are added to the table Before closing a cavity When closing the first layer and upon final closure When a scrub or circulator person is relieved.

Safety Improvement plan Adjuncts to use in addition to manual counting: Bar coding RF wand or mattress Intraoperative x-ray

Bar coding labels are on the each radiopaque sponges Need to be scanned by a device before placed on the sterile field Scanned before each individual sponge is placed into the count bag Each sponge has a unique code so no two sponges have like numbers.

RF wand or mattress Detects sponges that have a chip in them Used at the end of the procedure to detect remaining sponges in the surgical site or area Does not uniquely identify the sponges

Intraoperative x-ray can also be used to detect retained items

TEAM: Risk management OR leadership OR team: Circulator Scrub Surgeon First Assist Anesthesia Perfusion

Value of collaboration: An inter-collaborative team to evaluate adjuncts to manual counting with best practice solutions integrated into current policies to prevent the retention of sponges during surgery

References 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 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 Williams, T. L., Tung, D. K., Steelman, V. M., Chang, P. K., & Szekendi, M. K. (2014). Retained surgical sponges: Findings from incident reports and a cost-benefit analysis of radiofrequency technology. Journal of the American College of Surgeons, 219(3), 354-364. https://doi.org/10.1016/j.jamcollsurg.2014.03.052