Suit settled over towel found in patient

I watched a show on Discovery Health about several people that had things left behind during surgery. It was really sad, because in the cases of these people, the tool or towel or whatever really did affect their lives forever more.

The show discussed the implementation of a new scanning system, where a bar code was attached to each towel and sponge. they were scanned in before surgery and scanned out after surgery. In the testing they would distract the "counting" nurse several times while she was scanning. But because they were accounted for by the computer and not manually,. it was impossible for her to lose count or double count. Hopefully this will catch on and we won't see this anymore.

A year or so after I gave birth to my last daughter, my doctor was sued by another patient who had a difficult birth. Because of excessive bleeding, they used a lot of sponges. Apparently they didn't count correctly and accidentally left one. The woman developed an infection.

The woman began having severe pain and returned to the hospital and they checked her, said everything was ok and sent her home. I believe they did it again a few days later. Eventually, she returned to the hospital in grave condition, they operated, found the sponge and had to do a historectomy.

The family sued, because of not just what the woman went through and almost dying, but because they were now in a place where they could not have any more children (this was their first child).

I know stuff like this happens, we're all human. It's just tragic when it causes something that could have been avoided and effects the rest of your life or causes death.

I'm glad they're now using a back-up check. Leave nothing to chance when a life is at stake.

JMHO
fran

JBean said:

I watched a show on Discovery Health about several people that had things left behind during surgery. It was really sad, because in the cases of these people, the tool or towel or whatever really did affect their lives forever more.

The show discussed the implementation of a new scanning system, where a bar code was attached to each towel and sponge. they were scanned in before surgery and scanned out after surgery. In the testing they would distract the "counting" nurse several times while she was scanning. But because they were accounted for by the computer and not manually,. it was impossible for her to lose count or double count. Hopefully this will catch on and we won't see this anymore.

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This is an excellent idea. On some smaller cases where towels aren’t supposed to be able to fit into the incision, they are not counted and have no Xray tag on them (smart or not it’s done this way). In a chest they should be accounted for. Wonder if this was a count towel or not??
We're still left hand counting at least 100 instruments per tray opened and I've seen more than ten trays open on some cases.

crypto6 said:

This is an excellent idea. On some smaller cases where towels aren’t supposed to be able to fit into the incision, they are not counted and have no Xray tag on them (smart or not it’s done this way). In a chest they should be accounted for. Wonder if this was a count towel or not??
We're still left hand counting at least 100 instruments per tray opened and I've seen more than ten trays open on some cases.

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I just don't know how you do it.
In this test, they had people asking her questions, the phone ringing, doctors asking for things etc.Since the count was being monitored by the scanner, there was no probelm.It wouldn't scan the same item twice and it was easy to see at the end what hadn't been scanned back in then was originally scanned out. Are miscounts a fairly regualr occurence? It seems like they would be.

JBean said:

I just don't know how you do it.
In this test, they had people asking her questions, the phone ringing, doctors asking for things etc.Since the count was being monitored by the scanner, there was no probelm.It wouldn't scan the same item twice and it was easy to see at the end what hadn't been scanned back in then was originally scanned out. Are miscounts a fairly regualr occurence? It seems like they would be.

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Too many for my taste. Some fix a miscount with an xray searching for tagged items or metal. Our team doesn’t accept miscounts and we look until we find it. Garbage cans, drapes, floors and shoes are the favorite hiding places. Your instrument handling is a lot crisper if you know you’re gonna be on hands and knees after a long day with magnifying loupes if you miss something, and if you were involved and have left, you’ll come back to help. I feel there are more falsely-labeled correct counts than we would like to acknowledge, and this equipment is unaccounted for; thankfully most of it probably winds up outside the patient. I’ve had only one in 20 years where a non-count non-tagged 2X2 inch cotton gauze sponge was found as a sub muscular “lump”, and the original surgery was before xray tagging (and probably electricity) and at a time when when cotton was used to tamp off bleeding and left if it couldn’t be gotten out without severe hemorrhage, so it may have been left intentionally. Woman had been doing great and continued to do so after.

Crypto6

crypto6 said:

Too many for my taste. Some fix a miscount with an xray searching for tagged items or metal. Our team doesn’t accept miscounts and we look until we find it. Garbage cans, drapes, floors and shoes are the favorite hiding places. Your instrument handling is a lot crisper if you know you’re gonna be on hands and knees after a long day with magnifying loupes if you miss something, and if you were involved and have left, you’ll come back to help. I feel there are more falsely-labeled correct counts than we would like to acknowledge, and this equipment is unaccounted for; thankfully most of it probably winds up outside the patient. I’ve had only one in 20 years where a non-count non-tagged 2X2 inch cotton gauze sponge was found as a sub muscular “lump”, and the original surgery was before xray tagging (and probably electricity) and at a time when when cotton was used to tamp off bleeding and left if it couldn’t be gotten out without severe hemorrhage, so it may have been left intentionally. Woman had been doing great and continued to do so after.

Crypto6

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wow Crypto thank you for that information. Very very interesting.