“Better safe than sorry.” As cheesy as it is, the old saying, in a way, has become a bit of a life motto for me lately. In a lot of what I do, I try to take the extra precautions, and sometimes extra time, to make sure things are done right. I find it makes me feel better and I feel I achieve better outcomes, too.
I was reminded of this saying as I wrote the safety article in this issue on retained surgical items (RSI). In the article (see page 26), Dr. Verna Gibbs, a surgeon and director of the NoThing Left Behind® project, discusses some of the problems in the OR that lead to RSI cases and what can be done to prevent these problems. The article focuses more on the most frequent RSI event — a retained surgical sponge. However, Dr. Gibbs provided important information on other RSI events, particularly related to the second-most commonly retained item — miscellaneous items and device fragments.
According to Dr. Gibbs, the problem with these types of surgical items is they cannot be as easily counted or detected by technology the way surgical sponges are now able to be counted and detected. This technology cannot necessarily replace the manual sponge counting practice in the OR, but it can serve as an adjunct, a “safety net” to reinforce that the sponge count is correct. There is no technology, however, that can serve as a safety net for accounting for miscellaneous items and device fragments. So, that responsibility falls on the surgical staff.
Therefore, Dr. Gibbs says better practices and communication between surgical colleagues is necessary to prevent these surgical items from being left behind. One important change is the role of the surgical technologist. The scrub tech, Dr. Gibbs says, should be the “content expert” on the surgical equipment used in a case. “They don’t have to know how [a surgical device] works, but they have to know the parts of it,” Dr. Gibbs says. “If they see or discover when it comes back from the field that they’re missing parts, they have to speak up.”
In a sense, they must be the “safety net” for accounting for these miscellaneous items. It got me thinking about how it can be difficult for a staff member speak up if they feel something is wrong or missing. This can mean stopping a procedure, causing stress in the OR and lengthening a surgery considerably. And with all those factors — what if you’re wrong?
It may be cheesy, but perhaps the answer is simple: "Better safe than sorry." Especially in the case of a retained miscellaneous item, in which there is no fancy technological safety net to say one way or another, it’s better to be safe. It's better to stop the procedure to ensure all items are accounted for than to leave something in patient. And, it seems it should be the new job of the scrub tech to enforce that rule, as hard it may be to speak up sometimes.
A surgical team is faced with a host of safety issues daily in the OR — an RSI case is just one of them. It’s important that everyone on the team is held accountable, and feels comfortable, in doing their part in preventing them. If being “better safe than sorry” means a positive outcome each and every time — I’d say it’s a pretty good motto to live by.
What’s your take? E-mail me at firstname.lastname@example.org