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OR Case Reaction_Sponge Count

OR Case Reaction_Sponge Count

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Published by Jet Bautista
OR case for reaction
OR case for reaction

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Published by: Jet Bautista on Jun 18, 2010
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06/18/2010

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BAUTISTA, Jesther Rowen B. OR, ITRMC, 7-3BSN III-1
Sponge Count Off, Patient Develops Sepsis, Surgeon Blames Nurse.
Johnston v. Southwest Louisiana Assn. 693 So. 2d 1195 ±LASponge Counts are a basic and critical safety measure during a surgicaloperation. In this case, the standard three counts were not performed. A spongewas left in the patient that would later lead to infection. When the issue went tocourt, the surgeon claimed "it was not his responsibility" to keep track of thesponges.The patient was admitted for surgical repair of a hernia. The operation wasperformed and the patient returned to the floors without obvious incident."A hernia is a weakness or defect in the abdominal wall. It may be presentfrom birth, or develop over a period of time. If the defect is large enough, abdominalcontents such as the bowels, may protrude through the defect causing a lump or bulge felt by the patient. Hernias develop at certain sites which have a naturaltendency to be weak; the groin, umbilicus (belly button), and previous surgicalincisions."Post-operatively, the patient's incision would not heal. It would soon after start to display signs of active infection.In investigating the situation, it would be found that a sponge had been left inthe patient in the Operating Room. The patient sued both the surgeons and thenurses who had assisted in the procedure.The patient claimed that substantial negligence on the part of the surgeonand nurses contributed to the sponge being missed and the development of complications. These complications, the plaintiff asserted, could have been avoidedhad proper procedure been adhered to. Specifically, if accurate sponge counts hadbeen maintained and the missing sponge accounted for.For the operation in question, less than a dozen sponges were required. Itwas standard policy and procedure for three sponge counts to be performed duringthe operation. Anytime there is a discrepancy, the surgeon is to be notified immediately.Upon notification, it is his duty to the patient to resolve the discrepancy to the best of his ability."In cases where there is an incorrect sponge count, wound closure absolutelymust not be completed (unless the patient is unstable) until the missing sponge isaccounted for. The surgeon should not pressure the nursing staff to ignore anincorrect count. If after appropriate steps have been taken to find the missing spongeor instrument and it is unsuccessful, every detail of the search should bedocumented and the surgery completed."
 
Neither the nurses or the surgeon involved stated that they clearly remember the operation in question. The nurses' documentation of the event would show thatonly a single sponge count had been performed. The hospital policy in effect at thetime required three per procedure."The nurses count the unused, sterile sponges and note on a form thatsponges were counted. When the surgeon completes the operation, the nurses doa second count by combining the number of unused sponges with the number of used sponges that have been removed from the patient. The total of the unused andused sponges must correspond to the number of sponges originally laid out prior tosurgery.If the sponge count does not correspond, the surgeon is to be notified by thenurses. The nurses complete a third count shortly before the surgeon closes theincision. If nurses fail to account for a sponge, they are to report this directly to thesurgeon. The nurses must note the results of the second and third counts on thesame form on which they noted the initial count."The surgeon in his notes would document that a third count had beenperformed. He also documented that only after receiving this confirmation from thenurse, did he "close" up the patient.Is it plausible that the surgeon simply documented as if by habit, that the thirdcount had been completed? A nurse documenting her assessment may sometimesby habit write "lungs clear" and "bowel sounds active x 4q." A moment later it isrealized that in fact that was not the case and a correction made. Could the surgeonhave fallen into the same trap?Upon discovery of the missed sponge and resulting infection, the surgeoninsisted that "counting sponges" was not his responsibility. He went on to explainhow in the body cavities they can become soiled with blood and take on the color of internal viscera.It was the surgeon's argument that it was the nurses' responsibility, not histhat a proper sponge count be maintained. The surgeon, not the nurse is the personmanipulating the sponges inside the patient's body. Can the surgeon release himself from responsibility for a sponge left in a patient because he relied on an inadequatesponge count given by a nurse?The standards of care clearly state that if a sponge is missing, the nurse mustnotify the surgeon. There's little mystery to the fact that objects "left" inside patient'sbodies can have catastrophic effects.The question remains, will the surgeon blaming the nurses get "off the hook"because a count was incorrectly reported?"While the surgeon may rely on the nurses' sponge counts the surgeon isultimately responsible and liable for any foreign object left in a patient after surgery.Only x-ray detectable sponges should be utilized. A retained sponge occurs almostalways in the presence of a normal sponge count."

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