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."