Preventing retention of surgical items in intra-abdominal surgeries: a best practice implementation project

Retention of surgical items (RSI) is a "never event" and has serious consequences for patients, providers, and the organization.

This project aimed to implement best practices for surgical counts to reduce the incidence of RSI in patients undergoing intra-abdominal surgery.

This project followed the seven-phase JBI Evidence Implementation Framework. The framework recommends a before-and-after audit and feedback approach. A baseline audit was conducted to determine current compliance with best practices. Strategies were then implemented to address gaps in compliance, and two follow-up audits were conducted to measure changes in compliance. The audits used five evidence-based criteria adapted from JBI Evidence Summaries, with a sample size of 30 patients.

Although there was moderate to high compliance (50% to 100%) for four of the five criteria in the baseline audit, compliance was low for "surgical pause" (Criterion 4; 16.7%). A key barrier was that surgeons failed to conduct wound exploration before wound closure, despite reinforcement by nurses. Including surgeons as key stakeholders in the revised "surgical pause" protocol significantly improved compliance, which rose to 66.7% in follow-up audit 1 and 86.7% in follow-up audit 2.

Following project implementation, compliance with best practices increased. However, human factor issues remain a challenge in mitigating the occurrence of RSI. Poor inter-professional collaboration and misalignment of values and attitudes toward improvement interventions could hamper efforts to reduce RSI events.

http://links.lww.com/IJEBH/A430.