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retained objects. "You don't have to count each sponge; you just look
at the holders. If there is an empty pocket, you have a problem, and
that patient can't leave the OR until the sponge is found."
You can download free signage from the NoThing Left Behind website (nothingleftbehind.org) to provide colorful visual cues and memory
joggers. There is a rack sign and an OR safety rules sign (both reminding staff, "Where are the sponges?"). An Incorrect Count Checklist
guides team members through the best practices to use when they
identify that a sponge is missing. Sponge ACCOUNTing can work in
concert with new technology detection systems that use radiofrequency-tagged sponges.
Staff keep a running total of the sponges added to the surgical field
on the wall-mounted dry-erase board, which should be easily visible
from anywhere in the room. During the procedure, they place used
sponges in a clear plastic bag-lined receptacle, such as kick buckets
or ring stands.
You take each discarded sponge from the receptacle, opening it to
ensure you have only 1 sponge. Fold it into an oval and put the
sponge in one of the bottom pockets of the holder. Continue loading
the holder, 1 sponge per pocket. Don't mix different types of sponges
within one holder. Load from the bottom up because if you're missing
a sponge at the end of the case, it's easier to see an empty pocket
from anywhere in the room if it's one of the top 2 pockets. If you load
top down, you'll have an empty pocket at the bottom of the holder,
which is hard for everyone else to see. At the final count, the surgeon
and nurses look at the blue-backed sponge holders and see that every
pocket has a sponge. This is the show-me step when the team can see
there are no empty pockets.
— Gail Guterl
S E P T E M B E R 2013 | O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E
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