Maimonides Medical Center has increased its OR patient safety by enhancing its protocols for ensuring no surgical items are left inside patients once surgeries are complete. The Brooklyn, N.Y., hospital uses the RF (radio-frequency) Surgical Detection System as an addition to the safety measures already in place during surgical procedures.
The idea to purchase the system for the OR came from David Feldman, MD, chief safety officer and vice chair of surgery, and Pam Mestel, RN, MSN, CNOR, executive director of perioperative services, said Alyssa Christie, RN, CNOR, team leader for general surgery, laparoscopy and geriatric. We have weekly education inservices, and it was during an inservice that [Feldman and Mestel] presented the system, Christie said. They showed us how it was used and said they wanted to implement it with our manual count.
Once staff was on board, company representatives came in and trained the nurses and staff how to use the system and helped them trial it, Christie said.
Primarily used by the circulating and scrub nurses, the system works through a relatively simple process and is used in addition to a manual count. The systems Blair-Port Wand is waved over the incision site to detect the special micro-tagged cotton towels and sponges used during surgery. The staff does three counts throughout the procedure an initial before surgery begins, a closing count just before the surgery is complete but before the skin is closed, and a final once the procedure is complete, she said.The RF Surgical Detection System consists of a self-calibrating console, handheld Blair-Port Wand and RF micro-tagged cotton materials.
When the surgery is nearly complete, the wand is first tested to ensure its working properly by being waved over one of the specially coded sponges. The staff waits for the audible tone and if all is well, the wand is waved over the incision site.
The circulating nurse, who is not sterile, turns on the generator and hands the sterile-draped wand to the scrub nurse, Christie said. When the wanding is done and no tone is heard, the surgeon continues closing. There is a final count right after closing and then another wanding is performed.
Like any new procedure, getting into a rhythm of using the system had its challenges. At first, staff looked at it as another step to be done, but once we were past the learning curve it became routine, Christie said. Its a step that takes such little time and its really not that intrusive.
The system is part of Maimonides policy and procedures in the OR and it is mandated staff perform wanding and document it in its intraoperative record. We use the system for all surgeries except cystoscopy, myringotomy procedures [ear tubes in children], percutaneous vascular procedures and hand or foot procedures. Or in cases where no soft goods, such as sponges, lap pads or towels, are used at all, Christie said.
On average, the system costs between $12 and $15 per surgical case. The cost is minimal considering the peace of mind it provides the surgical staff. Our goal is to prevent foreign body retention and this is just another step to help Christie said. That in itself saves the hospital money.
Maimonides is one of several sites participating in a study that uses the device to improve surgical counts and staff wound closure confidence. Preliminary results of the study, conducted by Chapel Hill, N.C.-based UNC Healthcare, were presented at a recent meeting of the American College of Surgeons Clinical Congress. Interim results concluded RF technology speeds the identification of foreign bodies reducing the use of radiation to locate missing surgical items and that 90% of nursing staff reported the technology decreases stress during wound closure and improves confidence that no surgical supplies were left in the patient.
Maimonides has been using the system since December 2009 to complement its already working safety procedures. We decided to adopt this knowing how important it was to prevent retained surgical items, Christie said. We thought this additional safety measure was worth the additional expense.