Factors influencing incorrect surgical counts in the operating room

Rowlands, Aletha Elizabeth, School of Nursing, University of Virginia
Merwin, Elizabeth, School of Nursing, University of Virginia
Yan, Guofen, MD-PBHS Public Health Sciences Admin, University of Virginia
Baernholdt, Marianne, School of Nursing, University of Virginia
Cox, Kathleen, School of Nursing, University of Virginia
Turrentine, Florence, MD-SURG Surgery - Admin, University of Virginia

Determining the factors that are associated with medical errors is crucial for today's operating room environment. Estimations of errors occurring while patients are in the operating room range from 35% to 66% and research demonstrates that the majority of these errors are preventable. One persistent but poorly understood error in the operating room is incorrect surgical counts. This cross-sectional study provided evidence regarding factors influencing incorrect surgical counts in the operating room.

The Quality Health Outcomes Model guided a review of the literature for variable section and hypothesis development. Data abstracted from electronic perioperative medical records and primary data collected from perioperative nurses was used to determine factors central in the prediction of incorrect surgical counts. Additionally, the rate of incorrect surgical counts of the operating rooms involved in the study was determined.

Findings indicate that patient characteristics (lower body-mass index and poorer physical status), staff involvement (multiple surgical teams and a greater number of perioperative nurses), and intraoperative circumstances (difficult procedures, emergencies or procedures with unexpected changes) are associated with the occurrence of an incorrect surgical count. In this study, nurse characteristics (education, experience, certification, and employer status) were not significantly associated with an incorrect surgical count.

Identification of the risk factors shown in this study to be important may influence patient safety practices and operating room policy to reduce these types or errors. The implementation and use of standardized organizational regulations and strict adherence to standards developed by the Association of periOperative Registered Nurses should be continuously emphasized. Additional patient safety practices may be indicated for patients with higher risks of incorrect surgical counts.

PHD (Doctor of Philosophy)
Operating Room Nursing--standards, Operating Rooms--standards, Medical Errors--prevention & control, Safety--standards

Spine title: Incorrect surgical counts

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