Counting basics #8-when to count

We’ve covered the what of counting. And touched on the why, which is not leaving an item behind when it is not intended.

Let us discuss the when.

The initial count should be completed before the surgical blade makes the first incision. Or before the knife is passed over to the surgeon. Ideally, it should be before the patient is in the room.

Now that is not realistic at times. But try.

The count should be amended any time a new sponge, or blade, or instrument, or stapler load, or needle is added to the count.

Yes, every time. As soon as the addition is made, make the change on the count board. Don’t think to yourself, oh I will add that in a minute, let’s see what the email says.


Don’t do it.

You will forget.

Oh, look! The surgeon has called for closing suture. Now is a great time to do the closing count. Depending on where you work, this may be different. At my hospital it is policy that the surgeons not interrupt the count for anything. And really, a count should be less than two minutes. They can close away, just make sure to give them scissors.

There are two types of closing counts. There is the one where a cavity has been entered, think uterus, or bladder. There should be a complete count at the closing of the cavity. And again for closing the abdomen. Don’t let the surgeon bully you into splitting attention away from the count to attend to them. Unless there is a catastrophic problem, such as the patient coding. And in my twenty-two years as a nurse that has happened ONCE!

The last count should be the skin count. The closing count for the instruments and everything has been done and is correct. And the surgeon is asking for the skin suture, or the staples. Time to count again.

We are count happy in the operating room.

But only soft goods and sharps are needing to be counted for this count.

And then the circulator and the scrub tech will be quite busy with the dressing, and the bed to move the patient on to, with calling for help during the day, and calling for the PACU nurse at night to help move. Isn’t it good to know that all the counts are done already?

Next week the counting basics subject will be what to do if the count is wrong.

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