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THEATRE POLICY THE COUNT FOR SWABS, INSTRUMENTS & NEEDLES

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					                THEATRE POLICY
  THE COUNT FOR SWABS, INSTRUMENTS & NEEDLES.



Reference Number:                      415 2009


                                       John Hughes Senior Operating Assistant
Author & Title:                        Jayne Croucher Manager



Responsible Directorate:               Surgical Division


Review Date:                           September 2012


Ratified by (committee):               Surgical Board


Date Ratified:                         30th September 2009


Version:                               3



Related Policies                       Infection Control. Theatre Practice.




Document name: Theatre Policy Count for Swabs,                         Ref: 415/ 2009
Instruments and needles
Issue date: September 2009                                               Status: Final
                                      Page1 /19
Index:

1. SCOPE OF POLICY ________________________________________________________ 3
2 .PROCEDURE FOR COUNTING SWABS, NEEDLES AND INSTRUMENTS IN THEATRE _ 4
3 .PROCEDURE FOR DISCREPANCY DURING THE COUNTING OF SWABS, NEEDLES
AND INSTRUMENTS IN THEATRE______________________________________________ 5
4 .TECHNIQUE FOR COUNTING SWABS, NEEDLES AND INSTRUMENTS _____________ 6
REFERENCES ______________________________________________________________ 7
CONSULTATION AND RATIFICATION SCHEDULE ________________________________ 8
CONSULTATION CHECKLIST _________________________________________________ 9




     Document name: Theatre Policy Count for Swabs,        Ref: 415/ 2009
     Instruments and needles
     Issue date: September 2009                              Status: Final
                                           Page1 /29
1.     SCOPE OF POLICY

The counting of swabs, instruments and needles policy covers all theatres within the R.U.H,
and all patients undergoing surgery.

It is the intention of this policy to identify good clinical practice within theatres, and to ensure the
health and safety of patients throughout their journey within the operating theatre.

1.1    Responsibilities of the team leader are to ensure that:

       1.1.1 Staff maintain a safe standard of swab, needles and instrument checks within the
             theatre suite.
       1.1.2 Staff have appropriate training in the procedure for swab, needles and instrument
             checking
       1.1.3 Ensure a reliable assessment of blood / fluid loss from swabs is made during
             surgery, documented in the appropriate place and that information shared with the
             surgeon and anesthetist.
       1.1.4 Ensure that universal precautions are used at all times when handling soiled
             swabs needles and instruments.
       1.1.5 All contaminated swabs, needles and instruments are disposed of as described in
             the procedure.

       IT MUST BE NOTED THAT TWO PERSONS ARE REQUIRED FOR THIS
       PROCEDURE; ONE MUST BE AN IDENTIFIED PRACTITIONER.


              IDENTIFIED PRACTITIONERS ARE AS FOLLOWS:
                  ODP (operating department practitioner) or First / Second level Nurse.
       Nurses new to theatre must have completed competencies in learning outcomes
       package.

Second person may be as above or HCA or Dental Nurses who have passed their
competency to undertake the role.




      Document name: Theatre Policy Count for Swabs,                            Ref: 415/ 2009
      Instruments and needles
      Issue date: September 2009                                                  Status: Final
                                            Page1 /39
2 .PROCEDURE FOR COUNTING SWABS, NEEDLES AND INSTRUMENTS IN THEATRE

      2.1.1 At the beginning of each case a swab, instrument and needles count will be
            performed between the scrub and circulating person, they will be checking that
            there is a radiopaque line in the swab, and that all bundles of swabs are secured
            with a red string. Instruments must also be checked for integrity.
      2.1.2 The swabs must be recorded on the white board in multiples of 5’s e g. 5 + 5 + 5,
            as subsequent packs are opened. Extra instrumentation must be recorded on the
            white board.
      2.1.2 The red string tags around the swab packs must be retained by the scrub person
            as an additional check of numbers of swabs.
      2.1.3 The swabs used for preparing the skin will be handed to the circulating person
            who will keep them until he / she has the required number of five.
      2.1.4 The scrub person will retain all used swabs, needles and instruments from the
            operation, in a sterile container, safely avoiding blood spillage and splashing.
            Swabs considered dirty, e.g. Faecal contamination should be dropped into a
            conveniently placed bowl.
      2.1.5 The scrub person will indicate to the circulating person at any appropriate time,
            when 5 or multiple of swabs have accrued.
      2.1.6 The circulating person will have a clear plastic bag available and marker pens so
            that the bags will be marked as they are used, with the number and types of
            swabs within the bag.
      2.1.7 The circulating person; whilst wearing gloves will present an opened clear plastic
            bag to the scrub person, who will count out 5 or appropriate numbers to accrue 5
            swabs of equal size. The bag should be clearly marked and tied accordingly. The
            swabs should be weighed at this point, if required, and the accumulated totals
            recorded on the count board and blood loss form. The information should also be
            passed to the anesthetist.

Swabs that have already been placed in a clear plastic bag and labeled appropriately, can be
placed in a SEPARATE marked yellow bag (NOT THE CLINICAL WASTE YELLOW BAG),
which must remain in theatre throughout the case. With instructions from the scrub person, the
count on the board will be adjusted to indicate that these swabs have been counted down e.g.
5 + 5 + 5 etc…..

      2.1.8 The final swab, instruments and needles count will include only the remaining
            swabs, instruments discarded on the floor or handed out, and needles in
            circulation, i.e. swabs not crossed through on the white board should be counted
            in multiples of 5.
      2.1.9 Swab, instruments and needles checks must take place:
            Closure of an organ i.e. stomach or uterus
            Closure of peritoneum
            Closure of any layer as appropriate
            Final closure of skin layer


      Document name: Theatre Policy Count for Swabs,                     Ref: 415/ 2009
      Instruments and needles
      Issue date: September 2009                                           Status: Final
                                            Page1 /49
      2.1.10 The scrub person must confirm with the surgeon that the swabs, needles and
             instruments are correct, and obtain an acknowledgement from the surgeon.
      2.1.11 At the end of the operation, when the final check is correct, the scrub and
             circulating person must sign the theatre register, the scrub person must sign the
             completed ORSOS care plan, and ORSOS documentation must be completed.
      2.1.12 If a patient undergoes several procedures, all swabs may be counted down and
             new counts commenced. However, all swabs, instruments and needles pertaining
             to a case, must remain in the operating theatre until the total numbers of
             procedures are completed.
      2.1.13 At the end of each operation, all swabs, needles and instruments are discarded
             and disposed of in accordance with the theatre policy on clinical waste disposal.


      A change of scrub personnel should only occur when absolutely necessary. If
      there needs to be a change, then it should be at an appropriate time and with the
      permission of the surgeon. A complete count of swabs, instruments and needles
      must be performed at the changeover and this must be recorded.

      If there are any changes in instruments or additional trays, all must remain in the
      theatre; and recorded on the white board, until the end of the procedure, and the
      final checks are deemed correct, and all swabs, needles and instruments are
      accounted for.


3 .PROCEDURE FOR DISCREPANCY DURING THE COUNTING OF SWABS, NEEDLES
      AND INSTRUMENTS IN THEATRE

IT IS THE RESPONSIBILITY OF THE SCRUB PERSON TO ENSURE:

3.1.1 The surgeon is informed immediately.
3.1.2 That no further suturing material is to be given to the surgeon until the discrepancy is
      resolved.
3.1.3 The patient remains in theatre until the swab, instruments or needle discrepancy is
      resolved.
3.1.4 A thorough search is made of all the discarded swabs, needles and instruments in the
      rubbish and laundry bags, and the floor.
3.1.5 A further search has been performed around and in the wound of the patient.
3.1.6 To inform the theatre coordinator about the discrepancy.
3.1.7 The patient has had an x-ray performed prior to leaving the operating theatre.
3.1.4 That a full investigation has been performed and documented in the operating theatre
      register, care plan and on the ORSOS system, then an incident form is to be completed
      if the missing swab, needle or instrumentation can not be found.
3.1.5 Swabs deliberately retained in the wound of the patient, should be documented in the
      theatre register – stating clearly the quantity and type of swabs retained. This must also
      be documented in the patients’ notes (to be completed by the surgeon). The count
      Document name: Theatre Policy Count for Swabs,                       Ref: 415/ 2009
      Instruments and needles
      Issue date: September 2009                                             Status: Final
                                            Page1 /59
      should also be recorded in the operating theatre register and on the Orsos system, that
      the final swab, needle and instrument check was incorrect and why.


4 .TECHNIQUE FOR COUNTING SWABS, NEEDLES AND INSTRUMENTS

4.1.1 This count must always be performed with two people; one of them being an identified
practitioner and the count should be undertaken by the same staff.
4.1.2 Both Practitioners must count aloud and in unison.
4.1.3 All items must be checked separately. With attention to radio opaque tapes in swabs and
        that screws in retractors are present at the beginning and end of the operation.
4.1.4 There must be no interruptions during counts of swabs, needles and instruments.
4.1.5 Documentation off the count must be made by both staff completing the procedure prior
        to the patient leaving the operating theatre. This should include ORSOS and the
        operating theatre register.


5. PROCEDURE FOR DEALING WITH DAMAGED OR FAULTY INSTRUMENTATION

5.1 Any damaged or faulty instruments must be identified and separated. The appropriate
check list must be marked with the fault or damage described clearly on it. The instrument
should be marked with the appropriate tag obtained from DSDU and returned with the tray to
DSDU.




      Document name: Theatre Policy Count for Swabs,                     Ref: 415/ 2009
      Instruments and needles
      Issue date: September 2009                                           Status: Final
                                            Page1 /69
REFERENCES

  1. Joint Memorandum MDU and RCN (1978) Safeguards against wrong operations.
     Revised 1978.

  2. Mumford M (1991) Swab racks are an old fashioned idea British Journal of Theatre
     Nursing Dec 1 (a) 20-1.

  3. National Association of Theatre Nurses (2004) Principles of Safe Practice in the
     Perioperative Environment Harrogate.

  4. Plowes D (1990) Life without swab racks NATN News Sept 27 (a) 11.

  5. Wilmot J (1991) Swab racks – dilemma solved British Journal of Theatre Nursing Dec
     1 (a) 23-4.

  6. United Kingdom central Council (1998) Guidelines for records and record keeping
     UKCC.

  7. NATN (1990) Resource book




    Document name: Theatre Policy Count for Swabs,                    Ref: 415/ 2009
    Instruments and needles
    Issue date: September 2009                                          Status: Final
                                          Page1 /79
CONSULTATION AND RATIFICATION SCHEDULE

Name and Title of Individual                           Date Consulted
Heather Cooper                                         May 2006
Jayne Croucher                                         May 2006
John Hughes                                            May 2006
Lynn Wallace                                           May 2006
Janet Rowland                                          May 2006
Justine Archman                                        May 2006
Anthea Northover                                       May 2006
Theatre Users group                                    May 2006



Name of Committee                                      Date of Committee
Surgical Division                                      30th September 2009




     Document name: Theatre Policy Count for Swabs,                          Ref: 415/ 2009
     Instruments and needles
     Issue date: September 2009                                                Status: Final
                                           Page1 /89
CONSULTATION CHECKLIST
Author, please attach this to each copy of the policy being sent to a meeting for
comments.
Dear Chairman, please would you review this policy at your committee and return any
amendments / comments to ____________________________ by _____ / _____ / _____

Title of meeting               ______________________________________

Date of meeting                 ______________________________________

Name of policy                  ______________________________________

Name of author                 ______________________________________
                                                                 Yes No                N/A
Are there any elements of this policy which present operational
issues that require further discussion? If yes, please provide a
contact name for the author.
___________________________________

Is the policy referenced?
Does the policy include a training plan?
If you are the appropriate forum, have the necessary
resources been agreed to implement this policy?
Is there a plan for policy implementation?
Does your meeting recommend further consultation with
groups or staff other than listed at the front of the policy?
Other comments
from meeting.




Policy accepted without further comment. (Please circle)                   Yes / No
Policy needs further amendment. (Please circle)                            Yes / No

Name of Chair __________________________

Signature ______________________________                 Date _____ / _____ / _____
For Human Resources Policies only
Name of Staff Side ______________________

Signature ______________________________                 Date _____ / _____ / __


      Document name: Theatre Policy Count for Swabs,                        Ref: 415/ 2009
      Instruments and needles
      Issue date: September 2009                                              Status: Final
                                            Page1 /99

				
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