Abstract
Background: The inadvertent retention of quantifiable items (RIIQ) continues to be an occurrence in surgical realities, which entails catastrophic consequences for the patient. IIRQ prevention translates into a collective effort where all members of the surgical team must take responsibility and adopt preventive strategies. Objective: To determine what promotes surgical count (SC) practices that ensure surgical patient safety. Methodology: The literature search was carried out in the CINAHL and Pubmed databases. It included all studies published in English or Portuguese from 2016 to 2020. Results: 6 articles were obtained. Most episodes of IIRQ occur in general surgery surgeries and where CC has been performed. The achievement of the reported CC is 77.4% and 86.5%. There is a statistically significant correlation between instrumentalist nurses and CC. Factors such as emergent, long-term surgeries, inexperienced nurses, complacency in surgical counts, different surgical teams for the same procedure, and communication failures contribute to IIRQ. There is a relationship between body mass index (BMI) and the occurrence of IIIQ. Discussion: IIIQ is a sentinel event that has a direct negative impact on patient safety and health. The risk of IIIQ is not unique to abdominal surgery, and minimally invasive surgery is not risk-free. IIRQ occurs due to several factors, although CC alone does not prevent IIRQ, it is necessary to keep in mind that it is a surgical error and, like all errors, it is preventable. Conclusion: The correct practice of CC by perioperative nurses should be a priority in all surgical interventions. This practice contributes to the prevention of IIRQ, increasing the safety of the surgical patient.
References
Asiyanbola, B., Etienne-Cummings, R., & Lewi, J. S. (2012). Prevention and diagnosis of retained foreign bodies through the years: past, present, and future technologies. Technology and Health Care : Official Journal of the European Society for Engineering and Medicine, 20(5), 379–386. https://doi.org/10.3233/THC-2012-0687
Brooks, J. (2007). US Medicare will stop paying for preventable errors. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 177(8), 841–842. https://doi.org/10.1503/cmaj.071347
Chard, R., & Tovin, M. (2018). The Meaning of Intraoperative Errors: Perioperative Nurse Perspectives. AORN Journal, 107(2), 225–235. https://doi.org/10.1002/aorn.12032
Duarte, A., & Martins, O. (2014). Enfermagem em Bloco Operatório (Lidel (ed.)).
Endicott, K. M., Friedrich, R., Custer, J. W., Sarkar, R., Rowen, L., & Anders, M. G. (2020). Preventing Retained Surgical Items During Endovascular Procedures: Bridging the Gap Between Guidelines and Practice.
AORN Journal, 112(6), 625–633.
https://doi.org/10.1002/AORN.13250
Fang, J., Yuan, X., Fan, L., Du, M., Sui, W., Ma, W., Wang, H., & Pan, A.-F. (2021). Risk factors for incorrect surgical count during surgery: An observational study.
International Journal of Nursing Practice, 27(4), e12942. https://doi.org/10.1111/ijn.12942
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
Freitas, P. S., Silveira, R. C. de C. P., Clark, A. M., & Galvão, C.
M. (2016). Surgical count process for prevention of retained surgical items: An integrative review. Journal of Clinical Nursing, 25(13–14), 1835–1847. https://doi.org/10.1111/jocn.13216
Gawande, A. A., Studdert, D. M., Orav, E. J., Brennan, T. A., & Zinner, M. J. (2003). Risk factors for retained instruments and sponges after surgery. The New England Journal of Medicine, 348(3), 229–235. https://doi.org/10.1056/NEJMsa021721
Hariharan, D., & Lobo, D. N. (2013). Retained surgical sponges, needles and instruments. Annals of the Royal College of Surgeons of England, 95(2), 87–92. https://doi.org/10.1308/003588413X13511609957218
Işık, I., Gümüşkaya, O., Şen, S., & Arslan Özkan, H. (2020). The Elephant in the Room: Nurses’ Views of Communication Failure and Recommendations for Improvement in Perioperative Care. AORN Journal, 111(1), e1–e15. https://doi.org/10.1002/aorn.12899
Lei n.o 156/2015, de 16 de setembro, Pub. L. No. Diário da República: Série I, n.o 181, 8059 (2015).
Moffatt-Bruce, S. D., Cook, C. H., Steinberg, S. M., & Stawicki,
S. P. (2014). Risk factors for retained surgical items: a meta-analysis and proposed risk stratification system. The Journal of Surgical Research, 190(2), 429–436. https://doi.org/10.1016/j.jss.2014.05.044
Norton, E. K., Martin, C., & Micheli, A. J. (2012). Patients count on it: an initiative to reduce incorrect counts and prevent retained surgical items. AORN Journal, 95(1), 109–121. https://doi.org/10.1016/j.aorn.2011.06.007
OMS. (2009). Orientações da OMS para a Cirurgia Segura 2009. Organização Mundial de Saúde, 1–189. https://apps.who.int/iris/bitstream/handle/10665/44 185/9789241598552_por.pdf?sequence=8&isAllowed
=y
Ordem dos Enfermeiros. (2014). Norma para o Cálculo de Dotações Seguras dos Cuidados de Enfermagem. https://www.ordemenfermeiros.pt/arquivo/legislacao/Documents/LegislacaoOE/PontoQuatro%25257B%25 255C_%25257DNorma%25257B%25255C_%25257Dde%25257B%25255C_%25257DDotacoesSeguras%25257 B%25255C_%25257Ddos%25257B%25255C_%25257D Cuidados%25257B%25255C_%25257Dde%25257B%25 255C_%25257DEnfermagem%25257B%25255C_%252
Rowlands, A. (2012). Risk factors associated with incorrect surgical counts. AORN Journal, 96(3), 272–284. https://doi.org/10.1016/j.aorn.2012.06.012
Rowlands, A., & Steeves, R. (2010). Incorrect surgical counts: A qualitative analysis. AORN Journal, 92(4), 410–419. https://doi.org/10.1016/j.aorn.2010.01.019
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
Steelman, V. M. (2019). Retained Surgical Items: Evidence Review and Recommendations for Prevention. AORN Journal. https://doi.org/10.1002/aorn.12740
Steelman, V. M., Shaw, C., Shine, L., & Hardy-Fairbanks, A. J. (2018). Retained surgical sponges: a descriptive study of 319 occurrences and contributing factors from 2012 to 2017. Patient Safety in Surgery, 12(1). https://doi.org/10.1186/S13037-018-0166-0
The Joint Commission. (2013). The Joint Commision sentinel event alert: Preventing unintended retained foreign objects. Sentinel Event Alert / Joint Commission on Accreditation of Healthcare Organizations, 51, 1–5. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety- topics/sentinel- event/sea%7B%5C_%7D51%7B%5C_%7Durfos%7B%5 C_%7D10%7B%5C_%7D17%7B%5C_%7D13%7B%5C_%7Dfinal.pdf
Warwick, V. R., Gillespie, B. M., McMurray, A., & Clark-Burg, K. G. (2019). The patient, case, individual and environmental factors that impact on the surgical count process: An integrative review. Journal of Perioperative Nursing, 32(3), 9–19. https://doi.org/10.26550/2209-1092.1057
Zejnullahu, V. A., Bicaj, B. X., Zejnullahu, V. A., & Hamza, A. R. (2017). Retained Surgical Foreign Bodies after Surgery. Open Access Macedonian Journal of Medical Sciences, 5(1), 97–100. https://doi.org/10.3889/oamjms.2017.005
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