Surgical Counts for Certified Perioperative Nurse (CNOR)

Surgical Counts

Guidelines:

• Initial, cavity, closing, final
• Standardized per facility,the key is predictability
• Quiet, focused count is required
• All team members participate
• Circulator to be notified of dropped items
• Must be verbally acknowledged in time out
• 2 counters required, 1 must be circulator
• Multiple fields = count all together
  • Nottable by table
• Xray always an option
  • Very special care to micro
• Recognize emergent, skip count

Considerations:

• Separate items as counted
• No subtractions if at all possible
• Clear board of past cases!
• Trash stays in room until final count
• X-ray in room unless ICU
• Case can become emergent from routine
  • Count considered void, X-ray at end
• Do not cut radiopaque stitching
• Cut items recorded as 2
• Multi-piece per piece

Nurse’s role:

• Conduct counts
• Enforce group participation with count
• Coordinate with radiology for Xray
• RF sensors as indicated
• Training

Pitfalls:

• Intentionally left surgical items
• Multiple tables, multiple teams
• Nurse turnover
• Subtractions
• Emergent conversion unrecognized
• Skipped counts

Examples:

• Femoral artery ligation fails (Likely conversion to emergent, provide items to field for patient care is priority over counting)
• Abdominal Myomectomy how many counts (initial, cavity uterus, cavity abdomen, closing, final)

Linchpins (Key Points):

• Counts can become incorrect for many reasons, but should never result in RSI