OR Manager August 2023 - 28

Clinical evaluation of latest miscount management tool
PATIENT SAFETY
big question was circulating
amongst the OR professionals
at the AORN Global Surgical Conference
floor this year: " How do we improve
our miscount protocols? " It was
clear that nurses and OR managers are
looking for a better miscount management
solution.
A
Manual counting has been the standard
in preventing retained surgical needles
or instruments for a long time. But
with the rise of complex surgical procedures
that sometimes require hundreds
of tiny needles, a nationwide nursing
shortage, and the use of complex and
delicate instruments, miscounts are on
the rise.
Many nurses with whom I spoke at
the conference were curious about new
adjacent OR technology to manage miscounts,
like the Melzi™ Sharps Finder™
(MSF). The MSF is one of the latest innovative
tools used in ORs nationwide
to help manage miscounts, mitigate the
risk of retained surgical items, and potentially
improve patient safety.
One recent multi-institutional study
reviewed the efficacy of the MSF, and
one of the key surgeons involved sat
down with me to chat about the MSF
and share his thoughts. Before we get
into that, let's examine why so many
nurses want to improve miscount protocols.
Current
impact, challenges of
miscounts
Miscounts in the OR can harm patient
care, create a chaotic environment,
cause delays, and impact the psychological
well-being of the OR staff. And
relying solely on manual counting or
X-rays to prevent miscounts can lead to
inaccuracies, distractions, limitations,
and again, delays. These challenges
have led OR professionals to seek out
new adjacent OR technology.
Increased operating time. Extended
procedure time is one of the leading
patient safety issues during a miscount.
A miscount prevents the closure of the
28
OR Manager | August 2023
patient until the missing item is found,
potentially exposing the patient to prolonged
anesthesia and increasing the
risk of complications. Extensive procedures
may also require X-rays to locate
the missing object, subjecting the patient
to unnecessary radiation.
Added stress. For OR staff, miscounts
contribute to an even more
stressful and chaotic environment in
the OR. While the primary focus should
be locating the missing object, the
search can overshadow other critical
aspects of the procedure. The team
becomes consumed with finding the
needle or item, leading to heightened
stress and potential distractions from
other vital responsibilities.
Delays. Miscounts can also cause
delays in subsequent procedures and
commitments. If the surgical team cannot
promptly resolve a miscount, it will
disrupt the OR schedule, resulting in
cascading delays and possibly the rescheduling
of other procedures. These
delays can impact patient care, strain
hospital resources, and hinder the overall
efficiency of the healthcare facility.
Limitations of manual search,
X-Ray
Relying solely on manual counting presents
its own challenges. Count accuracy
depends on a perfect match between
the pre- and post-count. If the pre-count
is incorrect, subsequent counts will also
be inaccurate. The most critical issue
is when there are more items in the
post-count than the pre-count, leading
to serious uncertainty about whether an
object is missing. Concentration difficulties
in the OR, prolonged and complex
procedures with multiple shift changes
and many needles, and the inability
to count certain objects like broken instrument
pieces further complicate the
counting process.
Alternatively, relying on X-rays to detect
missing objects also poses challenges.
X-rays have limited capabilities
in detecting tiny needles increasingly
BY IVY MONTGOMERY
used in minimally invasive procedures.
Additionally, obtaining and examining
X-rays adds significant time to the case.
The process of inserting the film in the
OR table slot-if a C-arm is not available-making
sure not to contaminate
the sterile field, and waiting for the
radiologist to analyze the results can
take an average of 20 to 30 minutes
and add as much as 45 minutes to the
case.
Comprehensive strategies that
combine multiple methods and best
practices are the best way to minimize
miscounts and enhance patient safety.
Adjacent technoglogy such as the MSF
can help. The following is a Q&A with
Sam Weprin, MD, a member of the
team who worked on the recently released
MSF assessment study.
Q: You recently published a study in
Patient Safety in Surgery to assess the
MSF that involved several institutions.
Tell us about the study and the methods
used.
Many institutions were involved, including
Virginia Commonwealth University
Health, Stanford Health, the Graves Gilbert
Clinic, Yale School of Medicine,
University of Colorado, and Summit
Health. Generally speaking, the preclinical
assessment showed that the MSF
increased the rate of needle identification,
decreased the time to identification,
and improved the accuracy of determining
the presence of a needle.
The study comprised three steps.
The first was about identifying a retained
surgical sharp (RSS)
in a controlled
environment outside of a living
being. We set up this model using a
container with hay in a laparoscopic
trainer box. For the second step, we
wanted to see if the team could find
an RSS in live pigs during laparoscopic
procedures. We divided the pigs into
three groups: one using only a C-arm
machine, another with a C-arm along
with the MSF, and the last using just
the MSF.
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OR Manager August 2023

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