On the Prevention of Retained Surgical Items – Miscounts, Incorrect Final Counts, Correct Counts, No Counts and Ac-Count-ability: OR Counting Culture

August 17, 2023 | 11:00AM - 12:00PM PT

Now that ORs are moving back up to speed, there is an opportunity to NOT get back into old unsafe practice habits. This may be the time to tweak culture and apply a high reliability mindset to the review of OR surgical item management practices with a goal to act and count differently.

This webinar will review taxonomy and common areas of “count confusion” that decrease practice efficiency, impair team working relationships and may lead to surgical item retention events. Discussion will explore frequent types of surgical item management conundrums (sharps, multi-instrument trays, devices, towels and soft goods) and provide insight and suggestions for reliable and safe alternative counting actions. Learn to account for all surgical items, not just count them and enhance an understanding of ways to hold each other accountable. 

Presentation topics include:

  • Provide a taxonomy of retained surgical items
  • Clarify the six surgical counts and outline areas of confusion and error
  • Employ clinical case illustrations of “count confusion” and its contribution to surgical item retention   
  • List new practices to employ in the management of surgical items beyond counting
  • Utilize a just culture methodology to explain team member accountability

Thursday, August 17, 2023: 11:00 a.m.- noon (PT)

Verna C. Gibbs, MD
NoThing Left Behind®   

Dr. Verna Gibbs is a staff attending general surgeon at the San Francisco VA Medical Center. She is the founder and director of NoThing Left Behind®, a national surgical patient safety project for the prevention of retained surgical items and a clinical professor of surgery at the University of California, San Francisco.

A retained surgical item (RSI) is a surgical patient safety problem which is the result of the use of faulty practices and poor communication strategies by multiple OR team members. For the past 20 years, deliverables and guidance from Dr. Gibbs’ project has helped multiple stakeholders, implement better hospital surgical item management practices, adopt ways of clearly sharing knowledge and develop hospital specific data analysis tools. Many sites have reached and sustained improvements in preventing RSI.

Currently, Dr Gibbs is the Chair of the SFVAMC Surgical Service Quality Improvement Committee, a Physician Utilization Management Advisor and the faculty director of the VA Surgical Quality Improvement Program (VASQIP) at the SFVAMC. She is a member of the Anthem Blue Cross of California Physicians Relations Committee for Quality Improvement. She lectures widely and works with hospitals, business leaders, lawyers and innovators to explore multiple approaches to ensure at the end of an operation, there is NoThing Left Behind®. She can be reached at drgibbs@nothingleftbehind.org

HQI is an approved continuing education (CE) provider by the California Board of Registered Nursing and will provide CHPSO members an opportunity to earn CEs. Provider Number CEP16793 for 1.0 contact hour.

Please contact CHPSO at info@chpso.org if you have any questions.