Correct Counts in Trauma & Orthopaedic Theatres at Gloucestershire Royal Hospital

Quality Improvement Poster Download

Background & Problem

Surgical swabs, needles and instrument counts are easy to do – if you know how to do them. Everyone can count to 5 right? It’s how you do it that’s important and this has a major impact on patient care and patient safety. I set out initially to look at a historic problem of interpretation of how these counts were being completed. Each practitioner feeling that their interpretation of the policy was the safest but when you have two ‘safe’ procedures that are not the same then this increases danger and risk to patients.

This project set out to standardise the procedure and enable two theatre teams to undertake this safely and clearly to increase patient safety. Standardisation included the training, actions of the staff during surgery and the environment that we work in.

Two teams were chosen that had very different set ups and audits within PDSA cycles were taken. Due to personnel changes this was not possible so the project focused on one theatre – theatre 12 Spinal Surgery after the first PDSA cycle.

Aim

• To improve the compliance of Theatre 11 and Theatre 12 safety counts with the policy and procedure in line with AfPP guidance within T&O theatre at GRH
• To increase the compliance by 50% in the first month
• To further increase compliance by 25% for the second month

Method

A baseline audit was carried out to look at the issue and to see what improvements could be made. The audit highlighted numerous points that needed input and training to bring them in line with standards.

The policy and procedure was discussed and debate with the team to improve understanding of what the counts are and why we do them.

A further audit was carried out to gauge the impact of the session.

Training was implemented and a high level of engagement was recognised within my own theatre (12). Practitioners felt they wanted to get this right but had not received the input before which had led to discrepancies in the delivery of counts.

A further audit was carried out to gauge the impact of the session.

Lastly the environment was audited and changes made to this.

A final audit was carried out and results observe and analysed.

Results

The results initially showed such variations in the procedure it was difficult to see how these standards could be pulled up within the time frame I had initially set out but following small amounts of formal input good results were seen.

The impact has ensured that swabs, needles and instrument counts are now safer within theatre 12 and this has increased this element of safety for all patients undergoing surgery within this theatre.

Implications

Whilst it is clear to see a significant improvement in the counts it is also easy to see that this is only one theatre of many within the Trust. Variations exist because the policy and procedure allows this as it broadly sets out the process which can be open to interpretation. Policies such as this need to have a Standardised Operational Procedure to enable staff to fully understand every element of the procedure and in enough detail to prevent variances. There are now good opportunities for Theatres to take this and roll it out to all areas of theatres and to all theatres within the Trust leading to safer practice and a safer patient experience.