Surgical Counts & Safety Protocols Flashcards

According to AORN guidelines, when should the initial (first) surgical count be performed?

Answer: Before the procedure begins as items are being opened onto the sterile field

The initial count is performed before the procedure starts, as items are opened onto the sterile field. This establishes the baseline. Subsequent counts occur before closure of a body cavity, before final wound closure, and at any personnel change.

During an abdominal case, the scrub tech and circulator discover a discrepant sponge count at wound closure. What is the FIRST action to take?

Answer: Immediately notify the surgeon before closure proceeds

The surgeon must be notified immediately before closure proceeds. The surgeon then initiates a methodical search of the wound and room. Closing with an unresolved count discrepancy violates patient safety standards and risks leaving a retained surgical item.

What is the primary purpose of the Universal Protocol (Time-Out) immediately before surgical incision?

Answer: To prevent wrong-site, wrong-procedure, and wrong-patient surgery

The Universal Protocol, developed by The Joint Commission, requires active verification of patient identity, surgical site (including laterality), and procedure immediately before incision. Its sole purpose is to prevent wrong-site, wrong-procedure, and wrong-patient errors — classified as 'never events.'

Surgical sponges used inside body cavities must contain which feature to assist in detecting a retained item?

Answer: A radiopaque (X-ray detectable) strip

All surgical sponges intended for use in body cavities must contain a radiopaque marker (typically a barium sulfate-impregnated thread) visible on X-ray. If a count discrepancy cannot be resolved by recounting, an intraoperative radiograph can locate a retained sponge.

Which of the following item categories must be counted on every surgical case?

Answer: Sponges, sharps, and instruments

Standard surgical counts always include three categories: sponges (all types), sharps (needles, blades, electrosurgical tips), and instruments. All three are counted at procedure start, before body cavity closure, before wound closure, and at any shift or personnel change.

During a surgical time-out, who has the authority to pause the procedure if a discrepancy or safety concern is identified?

Answer: Any member of the surgical team

The Universal Protocol requires a culture of safety in which any team member — scrub tech, circulator, anesthesiologist, or surgeon — has both the right and the responsibility to speak up and halt the procedure when a safety concern arises during the time-out.