The ACS recognizes patient safety as an issue of the highest priority and strongly urges individual hospitals and healthcare organizations to take all reasonable measures to prevent the unintended retention of surgical items in the surgical wound.
Surgical procedures take place within a system of perioperative care composed of surgeons, perioperative registered nurses, surgical technologists, and anesthesia professionals. These healthcare providers share a common ethical, legal, and moral responsibility to promote an optimal patient outcome.
Prevention of unintentionally retained surgical items after surgery requires good communication among perioperative personnel and the consistent application of reliable and standardized processes of care.
Therefore the ACS recommends the following guidelines that can be adapted to various practice settings, including traditional operating rooms (OR), ambulatory surgery centers, surgeons’ offices, and other areas where operative and invasive procedures are performed:
- Recommendations to prevent the retention of sponges, sharps, instruments, and other designated miscellaneous items include:
- Consistent application and adherence to standardized counting procedures
- Performance of a methodical wound exploration before closure of the surgical site
- Use of X ray-detectable items in the surgical wound
- Maintenance of an optimal OR environment to allow focused performance of operative tasks
- Use of X ray or other technology (such as radiofrequency detection and bar coding) as indicated to ensure that no unintended item remains in the operative field
- Suspension of these measures may be necessary in certain life-threatening situations
- Documentation should include, but not be limited to, results of surgical item counts, notification of the surgical team members, instruments or items intentionally left as packing, and actions taken if count discrepancies occur.
- Surgical facilities must provide resources to ensure that necessary equipment and personnel are available to support these perioperative surgical safety measures.
- Policies and procedures for the prevention of retained foreign bodies should be developed, reviewed periodically, revised as necessary, and available in the practice setting.
- Disclosure of the event to patients and family members should follow the institution’s adverse event policy.
The ACS also endorses the National Quality Forum’s definition of “end of surgery” as the moment “…after all incisions or procedural access routes have been closed in their entirety, device(s) such as probes or instruments have been removed, and, if relevant, final surgical counts confirming accuracy of counts and resolving any discrepancies have concluded and the patient has been taken from the operating/procedure room,” where applicable.
