Does the Implementation of a Revised Surgical Count Checklist Help to Facilitate Handover and Counting Procedure among OT Nursing Staff ?
By Chan Shuk Yi, Umi, RN, BSN, MN (Operating Theatre)
The purpose of this project is to assess the surgical count practice for compliance with the new practice guidelines in Operating Theatre (OT). Also, to assess the effectiveness of a revised surgical count checklist. If appropriate, makes recommendations to improve practice.
It is well documented that an effective surgical counting system is essential to prevent the unintended retention of surgical items inside of patients. The total number of unintended retained instruments or materials among the hospitals of Hospital Authority in Hong Kong were 19 cases and 13 cases in 2015 and 2016 respectively. In 2010, Hong Kong Sanatorium & Hospital (HKSH) OT Department introduced a surgical count checklist to assist in the counting process and record surgical counts as a permanent part of the patients’ record. The total number of operation rooms of HKSH was increased from 10 to 15 in the period of 2013 to 2016. There was a trend of increased in new and complex procedures and instruments in recent years, thus, an electronic instrument tracking system was launched in 2016 for better tracking of used instruments in operations. It was time to assess whether the implementation of a revised surgical count checklist helped to facilitate handover and counting procedure among OT Nursing staff.
Staff satisfaction survey related to the implementation of the revised surgical count checklist was carried out in August, 2017. Total number of 60 questionnaires were distributed to randomly selected OT staff. Three audits, which included the practice compliance audit in May-July, 2017; the documentation accuracy audit in August and October, 2017 as well as the surgical counting time audit in October, 2017 were carried out to assess the practice compliance and effectiveness of the implementation of the revised surgical count checklist.
The response rate of the staff satisfaction survey was about 83 %. Most of the nursing staff agreed that the revised surgical count checklist helped to facilitate handover and counting procedure.
For the practice compliance audit, total number of 138 staff were audited. 135 (98%) nurses passed first time, three nurses (2%) passed their second audits after discussing the areas of weaknesses.
For the documentation accuracy audit in August, total number of 60 completed surgical count checklists were reviewed. 48 (80%) of them were completed accurately without mistakes and 12 (20 %) of them with missing or inaccurate items. Staff were then discussed concerns regarding to documentation. Another documentation accuracy audit was carried in October. Again, total number of 60 completed surgical count checklists were reviewed. This time, 58 (97%) of them were completed accurately without mistakes and only 2 (3 %) of them with missing or inaccurate items.
For the surgical counting time audit, total number of 30 operations were audited. With the use of revised surgical count checklist, the average counting time was about 20 minutes even for major cases. The results showed that the implementation of the revised counting method and checklist did not affect the staff’s counting efficiency.
An effective swab and instrument count practice plays a vital role in enhancing patient safety. When staff adheres to practice guidelines, the retention of a swab or instrument can be prevented. The count recording using actual number is beneficial for handover between different shifts by providing a clearer message of the surgical count. The checklist is an important tool for facilitating the surgical count. Concentration and focus without distraction during the counting process is also essential in preventing the retention of a swab or instrument. Staff need to be assertive in announcing surgical count time in order to minimize disruption during counting in progress.