The Association of periOperative Registered Nurses (“AORN”), which represents the interests of more than 160,000 perioperative nurses by providing nursing education, standards, and clinical practice resources, recently updated its guideline regarding so-called retained surgical items (“RSI”).
AORN’s RSI guideline provides guidance to operating room nurses to account for surgical items before, during, and after invasive procedures. The prevention of RSI is critical because RSI within a patient is considered a surgical never event, RSI is highly preventable, and RSI can result in very serious injuries.
What Are RSI?
RSI may include sharp objects such as needles; surgical instruments such as clamps and retractors; sponges; intravascular devices such as guidewires and catheter sheaths; and, other items that may detach or break off from devices used during surgery. AORN states that RSI may result from compromised system procedures and/or breakdowns in communication, suggesting that formal training programs that teach communication and teamwork will reduce the incidence of RSI (“Perioperative personnel should employ a consistent, standardized method to account for all surgical soft goods, instruments, needles, guidewires, and other items used during a procedure, as well as fragments from devices that can easily break off and remain in a patient’s body cavity”).
AORN’s updated RSI guideline recommends open communication among operating room team members, limiting distractions to ensure accurate counting, using a systems approach to quality improvement, accounting for countable items as well as device fragments, and using standard language to communicate critical information and ways to navigate potential hierarchical barriers, encouraging team members to clearly express any safety concerns and confirm that they have been heard.
AORN’s updated RSI guideline specifies that best practices to account for all surgical items should include consistent, standardized counting methods and that the initial count should be performed before the patient is brought into the operating room and that all forms of distractions in the operating room be limited while team members are counting surgical items (incorrect surgical counts may result from distractions due to the noisy environment in the operating room, electronic activities in the operating room, people entering and exiting the operating room, or may result from multitasking and time pressure in the operating room).
AORN notes that its updated retained surgical items guideline, which is currently in the process of being published, includes a decision tree to guide team members suspecting a discrepancy through the count reconciliation process.
The term “retained surgical item” is a contrived medical term used by surgeons and their medical malpractice insurers to describe leaving a foreign object in a patient during surgery that was not supposed to be left in the patient. The term retained surgical item may sound less offending or serious than the phrase “foreign object left in patient during surgery.” A patient who had a foreign object unintentionally or negligently left in him during surgery is justifiably concerned, if not angry, that he suffered a so-called medical “never event” that injured him.
If you or a family member may have been injured as a result of a foreign object left inside of you following a surgical procedure in the United States, you should promptly consult with a medical malpractice attorney in your state who may investigate your foreign object medical malpractice claim for you and represent you in a foreign object medical malpractice lawsuit, if appropriate.
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