Author Credentials

Sepideh Totonchilar: MSc student in operating room nursing, Department of Operating Room Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Akram Aarabi: Associate Professor of Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Aygineh Hayrabedian: Instructor of Operating Room Department, Research Center of Nursing & Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

corresponding author: Akram Aarabi


Background: Unintentionally retained surgical items (RSI) are a global problem contributing to adverse events for surgical patients. The Association of periOperative Registered Nurses (AORN) has developed a standardised protocol for the surgical count; however, many hospitals do not follow the protocol for the surgical count. This study was conducted to investigate the effect of implementing quality improvement interventions, for counting surgical sponges, on compliance with the AORN surgical count protocol and occurrence of count discrepancies.

Method: This study was performed as an interventional quality improvement project from 1 February to 20 September 2022 with an intervention and a control group in the gynaecology operating rooms of two selected hospitals. Thirty perioperative nurses and surgical technologists working in the gynaecology operating room participated in this study and the count process was observed during 130 open gynaecological surgeries performed through abdominal incision – 65 surgeries in one hospital were assigned to the control group and 65 surgeries in the other hospital were assigned to the intervention group. Data were collected through direct observation and interview with perioperative nurses using a tool designed by the researcher. The quality improvement interventions implemented in the intervention group were training in and use of sponge counter bags and surgical sponge count sheets and training about the AORN surgical count protocol. No quality improvement interventions were implemented in the control group, and the surgical count was performed as it had been before the study.

Results: Compliance with the AORN surgical count protocol was significantly (26.87%) higher in the intervention group than the control group. Count discrepancies were also significantly higher in the control group than the intervention group (21 vs 9, P = 0.04). The mean time required to correct count discrepancies was less in the intervention group, but the difference was not statistically significant. All count discrepancies in both the control and intervention groups were corrected and radiography to correct the discrepancies was not required in any of the surgeries included in the study.

Conclusion: The implementation of quality improvement interventions, including training in count protocol and using counter bags and count sheets, is recommended to improve the counting performance of perioperative nurses and reduce the incidence of count discrepancies and incorrect counts.

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.