What is the Board's Policy Regarding Retained Sponges, Needles or Instruments Despite Normal Counts by the Surgical Team?
Recently there have been several cases in which sponges, needles or instruments have been left in patients, leading to significant or potential postoperative morbidity.
Routinely, the Operating Room team does sponge, needle and instrument counts at the end of the case to ascertain that nothing is left behind. It is still the surgeon's responsibility and not entirely the nurses' responsibility for retained foreign materials even if the counts at the end of the case are correct. There are clearly types of cases where there is a higher probability of retaining foreign materials at the time of surgery, even after the assurance of a normal sponge count.
The risk of retained foreign material after surgery significantly increases in emergency cases, cases with unplanned changes in procedure, and/or cases with high blood mass index. Indeed, in those cases where foreign materials were left behind and there was a sponge, needle and instrument count, 88% of the time the sponge, needle and instrument count is listed as being correct.
There is an excellent special review article in the New England Journal of Medicine, January 16, 2003. The following is the link to the article: