Download Prevention of Retained Surgical Items – Second Assistant

[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Name:
Date:
Competency Statement: The RN or non-RN second assistant has completed facility or health care organization-required education and competency
verification activities related to prevention of retained surgical items.1
1.
Guideline for prevention of retained surgical items. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2016:369-414.
Outcome Statement: The patient is free from unintended retained objects.2
2.
Petersen C, ed. Retained foreign object. In: Perioperative Nursing Data Set. 3rd ed. Denver, CO: AORN, Inc; 2011:146-149.
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
1. Describes the occurrence of a retained surgical item (RSI) as a
a. preventable occurrence,
b. sentinel or “never” event, and
c. risk for every operative or invasive procedure.
2. Recognizes that all perioperative team members should engage in
safe practices that support prevention of RSIs.
3. Uses only radiopaque surgical items (eg, soft goods) in the wound.
4. Maintains awareness of the location of items in the surgical wound
during the course of the procedure.
5. Communicates placement of surgical items in the wound to the
perioperative team for notation in a visible location (eg, the count
board).
6. Acknowledges awareness of the start of the count process.
7. Removes unneeded counted items from the surgical field at the
initiation of the count process.
8. Assists with performing a methodical wound exploration before
closing the wound, using both visualization and touch when feasible.
9. Notifies the scrub person and RN circulator about surgical items
returned to the surgical field to complete the final count.
10. Communicates items left intentionally as packing.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 1 of 11
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
11. Participates in count reconciliation activities.
12. Immediately informs the RN circulator or members of the
perioperative team if an item is dropped from the surgical field.
13. Promptly informs the RN circulator about what was added when
assisting the surgical team by opening countable items onto the sterile
field.
14. Verbally verifies the final count as part of a checklist.
15. Participates in team training as a measure to prevent RSIs.
16. Minimizes distractions, noise, and interruptions during the surgical
count.
17. Creates a no-interruption zone that prohibits nonessential
conversation and activities and prohibits rushing during the count.
18. Recognizes that a count may be requested by any member of the
perioperative team involved in the counting process.
19. Recognizes that the count running total should be maintained in one
location.
20. Recognizes that counted items should remain within the OR or
procedure room until the counts are completed and reconciled.
a. Recognizes that linen or waste containers should not be removed
from the OR or procedure room until the counts are completed
and reconciled and the patient has been transferred out of the
room.
21. Does not consider the final count complete until all items (eg,
sponges, malleable retractors, needle holders, scissors) used in
closing the wound have been removed from the wound and returned
to the scrub person.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 2 of 11
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
22. Recognizes that a complete count should be performed when there is
permanent relief of the RN circulator or scrub person.
23. Recognizes that instrument counts may be waived for surgical
invasive procedures in which accurate instrument counts may not be
achievable or practical, including
a. complex procedures involving large numbers of instruments (eg,
anterior-posterior spinal procedures),
b. trauma procedures,
c. procedures that require complex instruments with numerous
small parts, and
d. procedures for which the width and depth of the incision is too
small to retain an instrument.
24. Recognizes that when instrument counts are waived, unless the
patient’s safety is at risk, intraoperative imaging should be performed
before the patient is transferred from the OR.
25. Recognizes that a critical investigation will be conducted regarding
any adverse event or near miss related to RSIs.
Surgical Soft Goods
26. Uses only radiopaque soft goods that are easily differentiated from
non-radiopaque soft goods (eg, sponges, towels) in the surgical
wound.
a. Does not use radiopaque sponges as postoperative dressings.
b. Does not use non-radiopaque sponges in the surgical wound. If
use of towels in the surgical wound is necessary, uses towels with
radiopaque markers.
27. Recognizes that counts of soft goods should be performed
a. before the procedure to establish a baseline (ie, initial count);
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 3 of 11
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
b.
c.
d.
e.
28.
29.
30.
31.
32.
when new items are added to the field;
before closure of a cavity within a cavity (eg, the uterus);
when wound closure begins;
when skin closure begins or at the end of the procedure when
counted items are no longer in use (ie, final count);
f. at the time of permanent relief of either the scrub person or the
RN circulator, although direct visualization of all items may not
be possible; and
g. any time a discrepancy is suspected.
Does not consider the final count complete until all surgical soft
goods used in closing the wound have been removed from the wound
and returned to the scrub person.
Leaves radiopaque surgical soft goods in their original configuration
and does not cut or alter them in any way.
Audibly communicates to the surgical team when radiopaque surgical
soft goods are placed in the surgical wound or other cavities (eg,
throat, vagina) and verifies recording of these items in a visible
location (eg, count board) on placement and removal.
If feasible, leaves a portion of the surgical soft goods placed in the
surgical wound or cavity outside the wound so that the item remains
visible.
Assists with performing a methodical wound exploration for
radiopaque surgical soft goods before closing the wound.
Pocketed sponge bag system
33. Recognizes that radiopaque surgical soft goods (eg, 4 x 4 gauze,
laparotomy sponges) should be organized using a pocketed sponge
bag or similar system.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 4 of 11
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
34. Places used sponges in a standard location (eg, kick bucket) until
transferred to a pocketed bag system.
Therapeutic packing
35. Communicates the number and types of radiopaque soft goods used
for therapeutic packing.
36. Takes the following actions when the patient is returned to the OR for
a subsequent procedure to remove therapeutic packing:
a. isolates the radiopaque sponges removed and
b. assists with performing a methodical wound examination.
Sharps and Miscellaneous Items
37. Recognizes that counts of sharps and miscellaneous items are
performed
a. before the procedure to establish a baseline (ie, initial count);
b. when new items are added to the field;
c. before closure of a cavity within a cavity (eg, the uterus);
d. when wound closure begins;
e. when skin closure begins or at the end of the procedure when
counted items are no longer in use (ie, final count);
f. at the time of permanent relief of either the scrub person or the
RN circulator, although direct visualization of all items may not
be possible; and
g. any time a discrepancy is suspected.
38. Recognizes that all suture needles, regardless of size, should be
counted for all surgical procedures.
39. Recognizes the need to account for miscellaneous items, including
a. catheter sheaths,
b. electrosurgery scratch pads,
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 5 of 11
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
c. endostaple reload cartridges,
d. guidewires,
e. cervical cups,
f. specimen bags,
g. stapler anvils,
h. bulb syringes,
i. trocar sealing caps,
j. umbilical and hernia tapes,
k. vascular inserts,
l. vessel clips, and
m. vessel loops.
40. Does not consider the final count complete until all sharps used in
closing the wound have been removed from the wound and returned
to the scrub person.
41. Confines and contains sharps on the sterile field in specified areas of
the sterile field or within a sharps container until the final count is
reconciled.
42. Uses sharps containment devices that are puncture resistant, labeled
or color coded in accordance with the bloodborne pathogens standard,
and leakproof on the sides and bottom.
43. Recognizes that in the event a needle or miscellaneous item is lost
during a minimally invasive procedure, the surgeon should weigh the
risks and benefits of retrieving the item.
Instruments
44. Recognizes that instrument counts are performed for all procedures in
which a body cavity (eg, thorax, abdomen, pelvis) is entered.
45. Recognizes that counts of instruments are performed
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 6 of 11
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
a. before the procedure to establish a baseline (ie, initial count);
b. when new instruments are added to the field;
c. when wound closure begins or at the end of the procedure when
counted items are no longer in use (ie, final count);
d. at the time of permanent relief of either the scrub person or the
RN circulator, although direct visualization of all items may not
be possible; and
e. any time a discrepancy is suspected.
46. Does not consider the final instrument count complete until all the
instruments used in closing the wound (eg, malleable retractors,
needle holders, scissors) are removed from the wound and returned to
the scrub person.
47. Recognizes that individual pieces of assembled instruments (eg,
suction tips, wing nuts, blades, sheaths) should be accounted for
separately.
48. Recognizes that all counted instruments should be kept within the OR
or procedure room during the procedure until all counts are
completed and reconciled.
Measures to Prevent Retention of Device Fragments
49. Uses instruments in accordance with the manufacturer’s instructions
for use (IFU).
50. Inspects instruments and attached labels before use to identify any
defects that may increase the likelihood of fragmentation.
51. Recognizes that instruments, including instrument labels, should be
maintained and serviced in accordance with the manufacturer’s IFU.
52. When notified of a missing device fragment, immediately
investigates and follows established count reconciliation procedures.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 7 of 11
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
53. Takes measures to prevent intravascular device (ie, catheter,
guidewire, sheath) fragments.
a. Recognizes that intravascular devices should be inserted and
removed in accordance with the manufacturer’s IFU.
b. Recognizes that catheters and guidewires should not be
withdrawn through a needle, and if withdrawn, should be
withdrawn simultaneously with the needle.
c. Recognizes that bent guidewires should be replaced immediately.
54. Recognizes that in the event a device fragment is retained, the
surgeon should weigh the risks and benefits of retrieving the item.
55. Recognizes that in the event an unretrieved device fragment is left in
the surgical wound, the surgeon should inform the patient or patient’s
representative of the nature of the item and the risks associated with
leaving it in the wound.
56. Recognizes that any deaths and serious adverse events associated
with device fragments should be reported to the US Food and Drug
Administration.
57. Recognizes that the device and fragment should be retained for
investigation.
Hypodermic needle fragments
58. Takes measures to prevent retention of hypodermic needle fragments.
a. Recognizes that thin (ie, 30-gauge) and short (ie, 20-mm) needles
should not be used unless clinically necessary.
b. Recognizes that hypodermic needles should be inspected for
defects that may increase the likelihood of fragmentation before
use and that defective hypodermic needles should not be used.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 8 of 11
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
59.
60.
61.
62.
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
c. Recognizes that hypodermic needles should not be inserted to the
hub.
d. Recognizes that the direction of the hypodermic needle should
not be changed during the injection, and if changing the needle
angle is necessary, recognizes the needle should be removed from
the tissue and repositioned.
e. Recognizes that thin (ie, 30-gauge) hypodermic needles should
not be reused on the same patient.
Count Discrepancy
Recognizes that all perioperative team members should take immediate
action to resolve a count discrepancy.
Assists with performing a methodical wound examination while actively
looking for the missing item.
Remains in the OR until the item is found or is determined not to be in
the patient.
Does not participate in nonessential personnel changes (eg, break, relief)
to occur until the count is resolved.
63. If the missing item is not recovered, recognizes that intraoperative
imaging should be performed to rule out a retained item before final
closure of the wound, if the patient’s condition permits.
a. If the patient’s condition is unstable, recognizes that the
radiograph should be taken as soon as possible in the next phase
of care.
64. Recognizes that when accurate accounting of surgical items is not
possible, intraoperative imaging should be performed before the
patient is transferred from the OR.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 9 of 11
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
65. Facilitates complete and detailed communication among the
perioperative team, radiology technologists, and radiologists during
requests for radiological support to prevent an RSI.
66. Facilitates performance of intraoperative imaging that provides full
coverage of the surgical site and inclusion of any views deemed
necessary by the surgeon and radiologist to maximize the opportunity
to identify a missing surgical item, which may include
a. using portable or fixed radiographic equipment,
b. taking portable anterior and posterior oblique views,
c. taking multiple images for full coverage of the surgical site or
body cavity as confirmed by the surgeon,
d. using fluoroscopy,
e. taking a sample image of an item similar to the missing object in
addition to imaging the surgical site, and
f. using computed tomography (CT) intraoperatively or
postoperatively when previous radiographic images are negative
and a high suspicion remains for an RSI.
67. Recognizes that the radiologist and surgeon should simultaneously
review and interpret intraoperative imaging for RSIs.
a. Recognizes that when the radiologist is not immediately
available, the surgeon should conduct a preliminary interpretation
of the image.
68. Verbalizes that radiographs are not used for needles less than
[facility-specific preference (eg, 10-mm)].
69. Notifies or recognizes that environmental services personnel and the
next perioperative team in the room should be notified about items
reported missing in an unresolved count discrepancy.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 10 of 11
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Prevention of Retained Surgical Items – Second Assistant (RN or Non-RN)
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
70. Verbalizes a review of facility or health care organization policies
and procedures related to prevention of RSIs.
71. Participates in assigned quality improvement activities related to
prevention of RSIs.


Concurrent competency verification of the following is recommended
[Additional competencies related to retained surgical items as determined by the 
facility or health care organization.]

DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 11 of 11