Accountability for Sponges, Policy # 0100
Sharps and Instruments
1.1 To provide guidelines of accountability for sponges, sharps and
instruments used during a surgical procedure. To provide safe practice for
the surgical patient, prevent patient injury and adhere to legal
2.1 All counts shall be audibly and visually performed according to procedure.
2.2 Incorrectly numbers packages of sponges and sharps shall be isolated and
not used during the procedure.
2.3 The Circulating Nurse and scrub person shall document the operative record
with the results of the counts.
2.4 For instruments having more than one part, the total number of parts shall
be accounted for.
2.5 Counts not done due to patient emergency shall be documented on the
operative record and incident report filed.
2.6 If the count is incorrect, the surgeon is notified, a recount is taken, a
search is made for the missing item and, if not found, an x-ray of the
patient is taken. If the item is not found on x-ray, documentation of x-
ray results is recorded on the operative record. If x-ray indicated item
is in the patient, document this fact and the course of action taken.
2.7 Patients are not to leave the OR until missing items are accounted for.
2.8 Raytec sponges are never to be utilized as packing or dressing.
3.1 All counts shall be taken before the procedure, when additional
sponges/sharps/instruments are added to the sterile field, prior to
closure of a cavity, prior to wound closure, and when permanent relief of
the scrub person and/or Circulating Nurse occurs.
3.2 All counts will be performed by two (2) people, one (1) of which is an RN.
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3.3 Counts shall always begin at the surgical field and surrounding area, then
to the Mayo stand, then to back table and lastly, the sponges, sharps or
instruments are discarded from the field.
3.4 Sponges shall be counted on all procedures involving a large body cavity.
3.4.1 Sponges shall be counted in the OR prior to, during, a s n