Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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sponges you opened, and how many you removed from the field." The RF detection approach, meanwhile, centers on a small RFID chip on each sponge. "It gives you that same accounting capability, but it also gives you the capability to detect where a sponge might be," says Dr. Cima. "You have a wand, and if you're in close proximity to the sponge, it'll tell you it's there." Mayo Clinic adopted the barcode technology years ago. "When you look at the literature, the most common reason sponges are retained is because of the counting problem," says Dr. Cima. "When a mis- count is identified, sponges are often located once the surgical team is aware they're missing." That's where Dr. Cima sees the true benefit of the barcode technology. "Staff place sponges under the scanner, see them register on the machine and monitor the counter," he says. "It's pretty straight- forward to know sponges have been counted." Tapping into the potential Dr. Marsh says it's not just important that OR teams use this technology, but also that they use it careful- ly and correctly. "As long as it's used right, it's 100% effective," she explains. "If you take shortcuts — if you don't individually scan out all the sponges, — that's when you get into trouble," she says. Once that message got through, Dr. Marsh's OR teams embraced the sponge-tracking technology. Today, an internship program Dr. Marsh devel- oped for nurses new to the OR includes ample edu- cation on the barcode-scanning system. "We go through the counting process as a circulator and then as a scrub person, so by the time they actually get into the OR on their own, they're well-versed on the machine," she says. Kathleen Langerman, BSN, RN, CNOR, MSN, evening charge nurse at Novant Health Huntersville (N.C.) Medical Center, reported a low initial utiliza- tion rate — less than 5% — of her facility's RF- based sponge detection machine. "It was abysmal," she says. "Surgical professionals don't like to be told 'you gotta.' They have to be shown 'you gotta.'" Learning about the substantial clinical and finan- cial cost involved with re-surgery due to retained objects hammered home the message for her staffers. "It was upwards of $60,000," says Ms. Langerman. "And nobody wants to be the nurse responsible for that." She also got her staff to buy in to using the technology by telling them adoption of the tech would eventually be tied to bonus criteria. Ms. Langerman even created an educational pro- gram for her coworkers, including surgeons, on proper use of the sponge detection system. "The main barrier was that OR staffers were confident in their manual counts, and thought they didn't need the extra step," she says. "But counts can be incor- rect, and we all know this." To help increase use of the technology, Ms. Langerman added use of the machines to prefer- ence cards linked to the health system's electronic health record. She says positivity was another key aspect of securing compliance. Brag Boards in every department lauded those who used the sys- tem. "In staff meetings, I wouldn't call people out specifically unless they were 100% compliant." Ms. Langerman also had one-on-one meetings with staff members who weren't compliant with the technology and put signs on OR doors and stickers on OR monitors that asked staffers, "Have you wanded?" The surgical team eventually came around. "It took us about four months to get compliance above 90%," says Ms. Langerman. Education and reeducation are key to success with this technology, says Ms. Langerman. "Be aware of barriers you might face," she says. "Mostly, it's consistency, and managing the expectation that this has to happen, because no one wants to be that nurse who left something behind." O C T O B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 1 9 "When you look at the literature, the most common reason sponges are retained is because of the counting problem." Robert M. Cima, MD