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Surgical Counts for Certified Perioperative Nurse (CNOR)

Surgical Counts for Certified Perioperative Nurse (CNOR)

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Outline

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

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Transcript

References

Association of periOperative Registered Nurses. (2022). Guidelines for Perioperative Practice (2022 ed.).

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