NBSTSA Surgical Counts & Safety Protocols — Questions and Answers
Question 1: According to AORN guidelines, when should the initial (first) surgical count be performed?
- After the patient is positioned but before incision
- Before the procedure begins as items are being opened onto the sterile field (Correct answer)
- After the surgeon makes the initial incision
- Immediately before wound closure begins
Correct 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.
Question 2: During an abdominal case, the scrub tech and circulator discover a discrepant sponge count at wound closure. What is the FIRST action to take?
- Immediately notify the surgeon before closure proceeds (Correct answer)
- Recount all sponges before notifying anyone
- Ask the surgeon to close and recount afterward
- Document the discrepancy and notify the charge nurse
Correct 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.
Question 3: What is the primary purpose of the Universal Protocol (Time-Out) immediately before surgical incision?
- To verify the surgical team has all necessary instruments
- To prevent wrong-site, wrong-procedure, and wrong-patient surgery (Correct answer)
- To confirm the anesthesia machine is properly calibrated
- To ensure the correct implants are available in the room
Correct 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.'
Question 4: Surgical sponges used inside body cavities must contain which feature to assist in detecting a retained item?
- A bright blue color for visual contrast
- A radiopaque (X-ray detectable) strip (Correct answer)
- A unique barcode for electronic tracking
- A numbered label on each sponge
Correct 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.
Question 5: Which of the following item categories must be counted on every surgical case?
- Suture needles only
- Sponges, sharps, and instruments (Correct answer)
- Sponges and sharps only
- Only items opened after the initial count
Correct 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.
Question 6: During a surgical time-out, who has the authority to pause the procedure if a discrepancy or safety concern is identified?
- Only the attending surgeon
- Only the anesthesia provider
- Any member of the surgical team (Correct answer)
- Only the circulating nurse
Correct 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.
