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Counting Basics #16- stray sponges and instruments

I’ve discussed 15 other types of counting basics. From what is counted, sponges, needles, and others to what happens if there is a miscount. Today I am going to write about the stray sponges and instruments.

One would hope that when a room is opened and prepared for a surgery that there are no stray sponges and instruments. In fact, the patient is depending on the counts being an accurate snapshot of all the countables.

A stray instrument is a not counted instrument. A stray instrument is also an instrument that is just hanging out on the computer desk, or in the marker tray under the white board. Or even used to hang the irrigation fluids. Or in the computer desk drawer.

This instrument is NOT included in the count.

Some of my coworkers call them the bonus instruments.

I call them a liability.

This goes for the sponges that are not included in the count but are just hanging out on the equipment boom, or on the shelves above the computer desk.

Some of this is to be saved for the worker in the room. I know I am of the thrifty sort and put aside sponges that have been passed off and not included in the count. For use at home.

But…

These stray sponges are not to be left in the room for the next surgery.

I’ll type it slowly. This is a liability!

Last week, after I took over for the day shift nurse and completed the surgery, and did the RF wanding (remember that?) prior to the closing of the incision. Like I’m supposed to. Well, when we were taking down the drapes, a raytec was taped over the foley catheter. Why? I don’t know!

But the scrub tech and I both looked at it, knowing full well I had RF wanded the patient not fifteen minutes before. I don’t know how they felt, but I felt sick.

This raytec was definitely not included in the count. We had done a relief count, and a closing count and a skin incision count and all 10 of the raytecs were accountable then.

Mystery sponge.

I will be discussing this with the nurse I relieved. And the manager.

My brain goes straight to the possibilities. None of them good. I cannot be alone in this.

These are new RF machines and apparently they are not as sensitive as the previous ones. I will be testing them this evening when I go into work.

No matter how you describe it, this is scary. And thoughtless. And leaves the previous nurse and tech as open to a lawsuit as myself and the evening tech.

Word to the wise, DON’T DO THIS!

And take the stray sponges and instruments out of the room prior to the surgery. Or count them. I don’t care which. But they have to accounted for. Our patients are vulnerable and they are depending on us to do the right thing.

Being accepting of stray instruments is not the right thing.

Ever.

Tuesday Top of Mind 5/28/24- incoming- misoprostol and mifepristone are now same schedule as opioids

Every day the right murmurs hold my beer when anything new comes out about the control of women. They are trying to one-up the other states in a massive race to the bottom.

I’ve discussed this at length.

They want to control WOMEN.

Full stop.

In Louisiana, the GOP legislature passed and the GOP governor signed into law that reclassifies mifepristone and misoprostol as the same schedule as opioids. Punishable with up to 5 years in prison.

This means that anyone caught possessing or using without a prescription. Or those who aid in the pregnant person obtaining the medication.

However, the law does say that the medications can be used for other applications besides abortion. In my experience, the drug mifepristone has been used to control bleeding after delivery. How kind and generous! (this is heavy sarcasm). Also kind is that women who are pregnant and possess the medications will not be charged.

Is the yet heavily implied? Or is that just me?

More like with every iteration of this insanity, they learn from each other and the mistakes that trip others up.

Are they screaming and scheming loud enough for you yet?

It is not about the fetus or the child to be.

It is, and has always been, about controlling women. If it were about the child there would be comprehensive health care both before and after birth, and subsidized childcare since women have to work to feed the child.

There goes Louisiana from the list of states I will currently travel to.

Pocketbook protesting.

If you know, you know.

Post-it Sunday 5-26-27- Outlook not so good, ask again later

The gown card reads “Surgery is not without its risks.”

My favorite thing is when people assume that surgery will solve everything.

Or should I say least favorite thing?

I get it. People want surgery to be an answer. Strike that. People want surgery to be THE answer.

My second least favorite OR thing is when people discount the c-section as not surgery.

Bitch, we opened up your belly like a can opener to get the baby out.

Understand?

I mean, we put it back together and stitched it up real nice. But the point is that someone was inside your abdomen, rooting around. There are all sorts of risks in this.

And people just answer no, no surgeries when asked in pre-op about previous surgeries. Only to casually drop that all four of their babies were born via section.

Um. That is major abdominal surgery. With a great prize at the end. But major abdominal surgery nonetheless.

But back to the least favorite thing with patients assuming that surgery is the answer to all their problems. Nope, not even a little.

There will be the risk of anesthesia. The risk of death. The risk of infection. The risk that the surgery might not even solve the problem that the patient is having. The risk that surgery itself will lead to another list of problems because of the risk of anesthesia, the risk of infection, or even the risk of it not being the appropriate surgery for their problem.

Why?

Because often to cut (do surgery) is to definitively find out what the problem is. Even if the problem was not the one that the patient and the surgeon thought they had.

Because your skin and insides are not transparent and until the surgeon gets a direct view of the problem, there is always the possibility of a missed diagnosis. Because although surgeons are excellent at their job (ahem, for the most part), they are not prognosticators.

This means they don’t have a crystal ball.

All they can do is their best.

And all the OR team can do is support them.

This is how you get the best outcomes for patients.

There is no magic 8-ball in surgery.

Imagine if there was.

School Me Saturday 5/25/24- the hookah-smoking caterpillar in the corner

In this continuing Alice in Wonderland/college/adult learner exploration, I would be remiss if I didn’t address the caterpillar in the room.

I am, of course, referring to the Blue Caterpillar who is first introduced to Alice by challenging her existence.

OOO….RRR…UUU spells the smoke as the Blue Caterpillar looks at Alice and placidly sucks on the hookah.

This is a very important question. WHO ARE YOU.

This is an answer that college will definitely challenge. After all, being in college usually means working toward a degree or a certificate that will redefine you. It is important to begin the journey with a sense of self.

During Alice’s time in Wonderland, the Blue Caterpillar is important, beginning with the first question. Her answer is that she doesn’t know, or, rather, that the answer had changed from that morning. Being aware of the changes in perception of self that college brings is also a very important nugget of information to have. Of equal importance is the acceptance that Alice has changed as a person, even since she woke up in the morning.

In my myriad of college experiences, I feel that I’ve remained the same person, even though that cannot possibly be the case. It is how others perceive me that has changed. I was a teenager in my first experience and I grew up. As one does. I was a CNA when I re-started nursing school after an injury. Through that journey, I became a telemetry tech and a uni secretary who just happened to do CNA tasks as well. After nursing school, I was a nurse. Going back to school for my BSN, MSN and now, I remain a nurse first, and a student second.

Every college experience is a journey. Hopefully, you or your Alice has a Blue Caterpillar to offer up things to eat for growth. Kind of like how students have to go through classes, learning and writing all the way, to get out the other side.

The Who Are You answer may fundamentally change.

Or it might not.

But growth is the way through college.

No matter how it is defined.

Cookie Thursday 5/23/24- Vietnam care package cookies

I called in sick last week.

No cookies were made. I’m telling you, I want off this ride that I’ve been on for 2 and a half months.

Today, I made the cookies I was going to make LAST week.

Soldiers rely on care packages. And what is Cookie Thursday is a Thing except a weekly care package to my coworkers in the OR? I keep coming back to healthcare is a war footing and healthcare workers as soldiers who are fighting the healthcare war.

This recipe I found when I was looking up war cookies. It is from Pinterest and the title of the pin is Action Vietnam Cookies. The blog this cookie recipe is from is Cookie Madness. The recipe was originally from a book called Food Writer’s Favorite Cookies.

Apparently, these cookies ship well and age well. The cookies themselves are made with no butter, instead with lard which helps with the shelf stability. I used Crisco.

They are an amalgam of bananas. oats, chopped walnuts, chocolate chips, cranberries, and coconut. They are seasoned with nutmeg and cinnamon.

When I dropped them off, several people were waiting. Because, you know, I missed last week.

I hope my coworkers feel taken care of with these weekly care packages.

I know that I feel more involved for having made them.

Tuesday Top of Mind 5/21/24- anti public mask law proposed in NC

Um.

Are they trying to kill people?

Or is this a desperate cry to their base and the millions of people who HATED to wear a mask in the worst public health emergency in 100 years?

Masks save lives.

Full stop. End of story. Masking to save lives was true in the Middle Ages and the Black Death. It was true in 1918 during the Spanish Flu Epidemic and it is true today.

But, but what about the masked fiends who are protesting? Or who are breaking laws? What about them?

Increasing penalties for committing a crime while wearing a mask I can kind of understand.

But protesting is not breaking the law.

And neither is going out masked because someone is medically vulnerable.

This bill would make it illegal to wear a mask out if the wearer were medically fragile.

Consigning them to house arrest.

That is not a good look for the NC legislature but they don’t care. Doctors and other health professionals (hello, I’m right here) have spoken out against this proposed legislation.

Make no mistake, this is mostly about the protesters who wear masks.

And control. It is ALWAYS about control.

But what about the white supremacists who are trying to hide their identity.

What about them?

Post-it Sunday 5/19/24- Easily amused

The gown card reads “I need a tee shirt that says Easily Amused.”

Yes, please. I would like that tee shirt.

I have lots of tee shirts. Because I find them amusing. They run the gamut of “save the bees…or else” to “Be Prepared.” This last is a Lion King reference with Scar on the front of the shirt, surrounded by green wafts of smoke.

I have pandemic tee shirts. I have vaccination tee shirts, I have two “Practice Safe Science” tee shirts.

Recently I bought a bunch of Star Wars tee shirts. What? They were on mega sale because of May 4th.

Most recently I bought several so-called women’s issues tee shirts. I have a “Roe, Roe, Roe, Your Vote” one, and a “They Won’t Stop at Roe” one. The ones that kicked off the protest tee shirts were an Alan Turing one I bought in 2020 and two different Ally tee shirts that I bought to volunteer last May for Pride. My current favorite is one that proclaims “He Who Hath Not a Uterus Should Fucketh the Hell Up”, attributed to Fallopians 19:73. I have 2 of that one, one a tee shirt and one a tank top.

The newest one is one with a rooster on it that says “Regulate Your Cock”.

I’m going to wear these for Tuesday Top of Mind posts. Or maybe, all week long. Until the November election.

To get me in the correct mind space.

So much about life in these United States these days is not amusing.

Far from it.

From the culture wars around LGBTQ+ and the rot of women’s reproductive health, and the book bans. These issues are ALL helped along with jerry-rigging of the states by the Republicans to ensure that they and they alone control the state houses and the governorships. All the while making it harder for people who are citizens to actually get out and vote.

So, yes, I will take several of those “Easily Amused” tee shirts. My sense of humor needs all the help it can get.

If you want to know how I am feeling, just read my shirt.

Or my head. My mowing hat says “Fuck These Laws” with reproductive health pins all over it.

But mostly read my shirt.

School Me Saturday 5/18/24- Brown v Board of Education

No, this is not an Alice in Wonderland School Me Saturday.

This is to celebrate the 70th anniversary of the landmark education case that was the Brown v Board of Education. This was to end the forced “racial” segregation of the black students and the white students.

This has been hailed as the start of school desegregation. And is known as a very good thing (literary reference).

Now, some people definitely thought this was a bad thing. They rioted and threw several fits over the very idea that the schools be desegregated.

They are still fighting. In my home state of North Carolina, the super majority legislature decided that it wasn’t fair that wealthy parents have to pay the entire cost of educating their precious children in a private school and they decided to start a school voucher program that does allow some disadvantaged students to attend a private school but mostly is a give away to the wealthy. After all the school voucher program, which is already out of money and holding their hand out for more, doesn’t cover all the cost of the private school. The parents of those who win have to pony up the rest.

It does further the interest in undermining public education which has been on the wishlist of those who don’t like public education. You know, the ones with the test scores, and the oversight. Especially the oversight.

I wonder how that will go.

As I tell my fellow operating room folks there is a reason for a policy and a rule. This does away will all the rules. Except for the ones that you can break with impunity because your daddy or mommy has the money to buy you out of whatever scrape you find yourself in.

I also wonder what Supreme Court Justice Earl Warren would make of the rollback of our rights.

I bet he would be disappointed in the current Supreme Court.

With their Originalism and their desire to control women.

By what means necessary. After all, have to ensure the continuation of the White Male Race, even if they have to steal a uterus to do so.

Apparently this School Me Saturday was School Me Saturday and Top of Mind Tuesday all in one.

Oops.

Brown v. Board of Education happened 21 years before I was born. The effects have been widespread and those who dislike it have been determined to undermine it.

Same shit, different decade.

Happy Hospital Week

Celebrating in the Operating Room.

It happens. And it usually involves food.

Strike that. It ALWAYS involves food.

This week is Hospital Week.

For the first time I can remember Nurses Week and Hospital Week have been separated. With an itty bitty overlap of May 12. May 12 is the day that Nurses Week ended. It traditionally ends on Florence Nightingale’s birthday.

Hospital Week is the week that the American Hospital Association sets aside to celebrate the 24/7 providers of care for their community. A hospital certainly ticks that box.

Food and bragging rights are good for a celebration.

This week we celebrate the workers of the hospitals, including nurses.

At my hospital, the week kicked off with an apple pie contest. Each department that cared to submitted a homemade apple pie. Monday, May 13th is National Apple Pie Day.

That is where the food comes in.

I made the apple pie for the operating room. I used homemade crust. I also peeled, cut, and cooked the apple pie filling. Even though the recipe that I was using said store-bought would be okay. Um, no. Have you met me?

I believe there were 12 apple pies submitted for the contest.

OR won 3rd prize.

There were also cupcakes to feed everyone else.

Because 12 pies are not going to feed the staff that run the 139 beds.

No matter how small the pieces.