NR 351 Week 5 Discussion: Using Evidence-Based Practice To Improve Patient Care

NR 351 Week 5 Discussion: Using Evidence-Based Practice to Improve Patient Care

NR 351 Week 5 Discussion: Using Evidence-Based Practice to Improve Patient Care

According to Rowlands, incorrect surgical counts are a common occurrence after surgery.  In reviewing incident reports from six hospitals during a three-year period, researchers found that incorrect surgical counts (25%) were the most frequently reported event.  Despite the availability of AORN standards and recommended practices and hospital policies, this type of error continues to occur (2012).

Rowlands also states, “the OR is a highly complex, error-prone environment characterized by nonstop activity, specialization, and intricate interdisciplinary processes.  The complexity is manifested not only in the patient and his or her condition but also in the sophistication of instrumentation and technology, which may increase the risk for error”.  “From the stories of preoperative personnel involved in incorrect surgical counts, three distinct themes emerged: bad behavior, general chaos, and communication difficulties”.

Working in the OR first hand I deal with the three themes mentioned.  I find it difficult to have everyone participate in the correct sequence as well as visualizing each item counted.  When I correct someone, I receive “looks”, hissing and a feeling that I am being too strict while I feel that other are too lax and do not take into consideration that policies dictate our process.  The patient and their safety, following policies and maintaining my licensure are the core of my practice.  Recently, I had a surgical technologist berate me for correcting a new surgical technologist in the way they were performing the count.  I received attitude from the new employee and was berated by the preceptor during the procedure.  I structure my counting based on the policy and so I know that I am performing my count according to AORN standards.  

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Moving forward in my practice, I will continue my counts as outlined in our policy.  I will continue to correct others when necessary and I will hold others accountable to follow the policy.  I do not play into unprofessionalism in my OR and I will address each situation as it arises.  When others disrupt the OR with unprofessionalism, I simply explain that we can discuss the situation at a later time.   

Researching in the Chamberlain Library for information regarding surgical counts, I began my search in the CINAHL complete tab, entered surgical counts on the first line and extended my search further with “risk factors associated with incorrect surgical counts”. I found a great journal article and used it along with my experience to complete my week 5 assignment.   


Hood, L. J. Leddy and Pepper’s Professional Nursing (9th ed.).  Philadelphia, PA Wolters Kluwer 

Rowlands, A. (2012). Risk Factors Associated with Incorrect Surgical Counts. to an external site. 

The only education videos I’ve seen are from the OB department. At my place of work, we don’t have a channel or IPADs to show the patients education. We have generalized education booklets for CHF, coumadin, open heart and others that we hand to the patients when we get a chance. Case management sometimes helps with giving patient education booklets too, but it seems like we (nurses) don’t have much time to sit down and educate the patients. We also have a database where we can print out education on different topics but it’s difficult to access and even then we’re sometimes just handing them to the patient. Most times I give the patients the printed material and ask them to look over it on their own and then go over it together when I am available. I try my best to educate the patients when I’m passing their medications and doing their assessments but sometimes the questions become too complicated and I then ask the patient to make a list of questions for the physician to answer when they round. I wish we had more options available for education like the options you mentioned. 

That does not make me feel comfortable about having surgery knowing that the incorrect counts are so frequent! I am glad that you are following the policy. Have you taken this issue up with your supervisor? Perhaps some education is needed. Your article was good but try to find one that is more recent. Our goal is to find one that is within the last 5 years. That is not always possible. I found an interesting article from Dec 2019 from the ORNAC Journal called Factors affecting inaccurate surgical counts and system based prevention strategies. Great problem identification.

In your reference, you need to include the journal name along with volume and issue number and page numbers. Here is how your reference should look…..

Rowlands, A. (2012). Risk factors associated with incorrect surgical counts. AORN Journal, 96(3), 272-284. You may then include the https.   

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