Authors (including presenting author) :
Ngan HT(3), Tong WK(1), Tsang CC(1), Wong YN(1), Ho SF(2), Ng HK(2), Chan YK(2), Szeto L(3), Lo WC(3), Yip WY(3), Fung CK(3), Chan SH(3), Li KH(3), Chiu CT(3)
Affiliation :
(1) Head office Nursing Service Department (2) Information Technology and Health Informatics (3) Department of Anaesthesia & Operating Theatre Services - Integrated Disinfection & Sterilization Services
Introduction :
Ensuring patients remain free from unintended retained foreign bodies (surgical item like sponges, needles, instrument) is a primary responsibility of perioperative nurses. However, retention of surgical related items still happening despite of hospital policies and recommended guidelines. According to Hong Kong Hospital Authority (2022) Annual Report on Sentinel and Serious Untoward Events 2021-2022, in the sentinel event category, retained instruments/ material contribute over 60%. Moreover, from the statistic of past ten years, at least 10 sentinel events related to retained instruments/material every year and there are 16 sentinel events about retained instruments/material in the year of 2021-2022. There is no doubt that retained instruments/material in patient body is the number one problem need to be solved.
Objectives :
Nursing leader from different cluster has come across with a standardized workflow for instrument counting in operation theater. The consensus of the standardized workflow includes: 1. Instrument counting should be carried out with at least two nurses (scrub nurse and circulating nurse or 2 circulating nurses if scrub assist is not required) 2. Instrument counting should involve at least one register nurse. (counting by two enrolled nurse/ scrub technologist is not allowed) 3. Initial/first counting of instrument should be carried out and completed before surgical procedure start 4. When there are change in scrub personnel/shift change over, additional counting of instrument is required 5. When there are closing of cavity, counting should be performed 6. Before closing the final cavity, second counting should be performed 7. Before wound dressing, final counting should be performed This set of standardized workflows is set to facilitate the software development of SITS mobile. Moreover, this standardized workflow is developed based on Halvorson, C.K. (2010), Goldberg, J. L., & Feldman, D. L. (2012) from AORN and ACORN (2014) recommendation. Apart from the standardization of workflow, there are addition feature to increase the patient safety during counting procedure. These features include: 1. Instrument tray content will include instrument photo for quick reference (old paper form checklist does not contain photo of the instrument) 2. Instrument alert for high-risk instrument (I.e., instrument with many small parts and instrument which is easily broken) 3. Standardized documentation in counting procedure and step by step counting practice (prevent nurses from skipping counting procedure and recording the responsible person in each counting stage)
Methodology :
A user satisfaction evaluation questionnaire is formulated and distributed to frontline users. The questionnaire include system design, training, workflow facilitation, risk assessment and user friendliness. And cost-benefit analysis of the project is done to evaluate the project design and implementation.
Result & Outcome :
The result of the questionnaire has shown that over 80% of frontline staff rated positive with the mobile application implemented for perioperative counting. The newly designed application can uphold and standardize the quality of instrument counting and aim to prevent retain surgical item. It is hoped that the further enhancement of function and roll-out to other cluster can reduce the overall RSI in HA. Moreover, the paperless workflow generated significant reduce and lean in operation workflow and operation cost.
