Keywords: An RSI is a rare but serious preventable error that can result in patient harm. 2. Gavrić Lovrec V, Cokan A, Lukman L, Arko D, Takač I. J Int Med Res. ��3�������R� `̊j��[�~ :� w���! [IIIA], 10. Managing the prevention of retained surgical instruments: what is the value of counting? The AORN Guideline for Prevention of Retained Surgical Items recommends the following: 1. The law does, however, require that surgical items not intended to remain in the patient be removed. Further research is needed to determine the incidence of RSIs. The retention of items within a patient after surgery is considered to be a serious issue within the health care community. )ɩL^6 �g�,qm�"[�Z[Z��~Q����7%��"�  |  �r�~�9��V�y3?��U�~�(!��X���/L��[9xF�K@�(~��-�)����+�5�ٔU"�.�B�����-k�aGđI�rf�zFfb}Mx1�q)�]�W�dIoI����9{>[g�؟-�����/F�:�]0\g�-LT����6Q�.��_v���Ɵ}�T�Gkۖ��� /[zoZ�8s�;Y� ԜQ��ĵ�m� ��e�]}d�l�\�@[,��yȏ��>�W��T��r���2��#���)��"��!� ��)� The retention of items within a patient after surgery is a considered to be a serious issue within the healthcare community. 2009;6(6):e1000097. Retained surgical items: a problem yet to be solved. [IIIB], 5. h��T]O�0�+�41;��*��B�1�RՇК�)M��H���޸�ۀ�a��^ߏ�[lB[�1��& �����i$�Z��(�)��i��m@DB��!K�n�U>sd���r�����?�|�i�$�',�ʣo�}8��#L5�ȋ��e�O��`������2_�tʮ�o~��-1�z� ��Q޺9XN�)B�/�6/[��3,�o���g.�x�r�rY� Death is a less common event, occurring in 2% to 6% of cases.4,6,19  Although emotional harm has not been uniformly reported, one publication estimated the prevalence to be 1.1%.19  Further research is needed to assess emotional harm to the patient who has experienced an RSI as this value is likely to be underestimated. 3. %%EOF Egorova NN, Moskowitz A, Gelijns A, et al. AORN recognizes the many diverse settings in which perioperative nurses practice; therefore, this guideline is adaptable to all areas where operative or other invasive procedures may be performed. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the guideline can be implemented. Natural history of retained surgical items supports the need for team training, early recognition, and prompt retrieval. Improving system reliability to enhance the performance of human factors may reduce error and improve patient safety.40  A systems approach to preventing RSIs includes using standardized counting and reconciliation procedures, methodical wound exploration, radiological confirmation, adjunct technology, team training,41,42  and enhanced communication to promote optimal perioperative patient outcomes.2,18,43-46. Lower-level or lower-quality evidence was excluded when higher-level or higher-quality evidence was available. Natural history of the retained surgical sponge. �Q���m�%����8ן�Ҧsh�����/�*鰽���5��M����.�TD;b���y k���Ů� �d�!/1�)�B�Ĕd�ػx4(J���?� Wrong-site surgery, retained surgical items, and surgical fires: a systematic review of surgical never events. J Am Coll Surg. [IIIA], 11. Cima RR, Kollengode A, Garnatz J, Storsveen A, Weisbrod C, Deschamps C. Incidence and characteristics of potential and actual retained foreign object events in surgical patients. CINAHL, Cumulative Index to Nursing and Allied Health Literature, is a registered trademark of EBSCO Industries, Birmingham, AL. Various estimates of RSI incidence have been reported in the literature (Table 1), although RSIs are widely thought to be underreported due to medicolegal consequences. Two cost-analysis reports of RSIs in pediatric patients estimated additional hospital charges to be $35,68126  and $42,07727  for this complication in 2010 and 2009, respectively. A medical librarian conducted a systematic search of the databases Ovid MEDLINE®, EBSCO CINAHL®, Scopus®, and the Cochrane Database of Systematic Reviews. The limitations of the evidence are that randomized controlled trials of RSI prevention interventions may expose patients to harm and, as such, would not be ethical.5  Case-control studies of RSI have been conducted and contribute valuable knowledge to the field. 2011;212(6):977-983. Szymocha M, Pacan M, Anufrowicz M, Jurek T, Rorat M. Pol Przegl Chir. Editor’s note: MEDLINE is a registered trademark of the US National Library of Medicine’s Medical Literature Analysis and Retrieval System, Bethesda, MD. Qf� �Ml��@DE�����H��b!(�`HPb0���dF�J|yy����ǽ��g�s��{��. J Pediatr Surg. 2003;348(3): 229-235. Retention of items can have disastrous outcomes for patients, such as in the case of a patient’s death from myocardial infarction caused by an unintentionally retained pacing wire. endstream endobj 59 0 obj <>stream %PDF-1.5 %���� Termed a ‘sentinel event’, a retained surgical item is one of eight reportable adverse events deemed to have the potential to seriously … endstream endobj startxref endstream endobj 58 0 obj <>stream Hempel S, Maggard-Gibbons M, Nguyen DK, et al. The Guideline for Prevention of Retained Surgical Items was approved by the AORN Guidelines Advisory Board and became effective January 15, 2016. 2016 Jul;104(1):37-48. doi: 10.1016/j.aorn.2016.05.005. The lead author divided the search results into topics and assigned members of the team to review and critically appraise each article using the AORN Research or Non-Research Evidence Appraisal Tools as appropriate. $E}k���yh�y�Rm��333��������:� }�=#�v����ʉe ���Z�Wh�&kX�ې�ޓ��rb�F;r��DN��Bzf�2n�d�����~�Uc�Q��%D��IP� ��/���m��"�oT��J���p6���4k A�8V��Fj6/��ڐ������&�Kh��ц��V.^��]�]Ĕ��&�����b���]Ɯ��V[ȑ8 9O0�Y�'4�8`��g��6�dN�ϧ�����(���MU�Ҡ�a [IIIA], 4. However, interpretation of these studies is limited by the nature of this type of research, which can only show association among study variables and cannot determine causation. Shah RK, Lander L. Retained foreign bodies during surgery in pediatric patients: a national perspective. 2008;207(1):80-87. �G��N���$ۮ��3�_�!�`��5�C/�җ$ S�?�7�L�jK�f9+��]�#[TA� pG�*QlT���o�6��E�,���g�r*r/������m���cN0����d;a8�#�S�d.�8�*5����-�]�_�^��H���ï������n��9�� � National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The literature was independently evaluated and appraised according to the strength and quality of the evidence. The doctrine of res ipsa loquitur (ie, “the thing speaks for itself”) is most applicable in RSI incidents. hޜ�wTT��Ͻwz��0�z�.0��. • Retention of a foreign object in a patient after surgery or other procedure, – excluding objects intentionally implanted as part of a planned intervention and objects present prior to surgery that are intentionally retained. [IVB], 8. 2013;216(1):15-22. Opinion leaders have established accounting protocols for prevention of RSIs that were not published in peer-reviewed literature during the time frame of this systematic literature search, and thus these were excluded from this document (Figure 1). Therefore, time and effort in legal tort cases is spent assigning blame or fault for the act because it is not always necessary to prove negligence. Infection is the most reported physical harm, with occurrence ranging from 10% to 43%.4-6  Development of a fistula or obstruction has been reported to be 15% to 18%, and perforation has been reported to occur in 3% to 7% of RSI cases.4-6  Mehtsun et al19  categorized physical harm as being temporary in 78.1% of patients and permanent in 16.3% of patients with an RSI. AORN J. Mehtsun et al19  estimated the cost of malpractice payments for a surgical retained foreign body to range from $51 to $3,988,829, with a mean of $86,247 and median of $33,953. 2009;44(4):738-742. For the prevention of retained surgical sponges the essential understanding for doctors, is to perform a methodical wound exam before closing every wound, and that includes examining the vagina after a birth. Lack of a universal definition of RSI and varying reporting requirements have limited the ability to interpret RSI data.19,47  Other issues that complicate the interpretation of RSI incidence include selection bias (eg, severity of cases, patient or payer mix, voluntary reporting), time frames for data collection, varying use of RSI prevention methods, and different procedural settings (eg, hospitals, ambulatory centers). Chen Q, Rosen AK, Cevasco M, Shin M, Itani KM, Borzecki AM. (�ǹ$#b$��3 �CHG�"=͈z>�;�`���=%�3���T;�C)��eD�Z>�qʞ�?H])�N�q���_]�e�z��'w�.W(�zR�R�)o��D�D D�N�і��~����f�� RETAINED SURGICAL ITEM DEFINITIONS National Quality Forum* The National Quality Forum defines retained surgical item as unintended retention of a foreign object in a patient after surgery or other invasive procedure. endstream endobj 55 0 obj <> endobj 56 0 obj <> endobj 57 0 obj <>stream Epub 2018 Sep 17. Retained surgical needle and gauze after cesarean section and adnexectomy: a case report and literature review. In a survey conducted by Steelman et al,20  61% of perioperative nurses identified the prevention of RSIs as one of the top priorities for perioperative patient safety. 2019 May 15;91(6):35-40. doi: 10.5604/01.3001.0013.2024. The recommendations in the guideline are intended to be achievable and represent what is believed to be an optimal level of practice. Note: The evidence summary table is available at Between June 2014 and April 2015, the results of alerts established at the time of the initial search were assessed, and the lead author requested additional articles that either did not fit the original search criteria or were discovered during the evidence appraisal process. Therefore, behavioral changes and an understanding of risk-reduction strategies unique to each setting should be employed in the adoption of systems to account for surgical items.