Accreditation

AORN guidelines on unintended retention of a foreign body focuses on counting and communication

Briefings on Accreditation and Quality, June 1, 2018

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 Two years ago, The Joint Commission released a "Quick Safety" report on unintended retained foreign objects. That report was meant to build upon the info in The Joint Commission’s 2013 Sentinel Event Alert 51, which also addressed retained surgical items (RSI).

Despite that, RSIs still topped The Joint Commission’s 2017 sentinel event statistics. Patients continue to be stitched closed with surgical sponges, gloves, needles, electrodes, scalpels, wires, tweezers, forceps, scopes, masks, tubes, and scissors left inside them. 

It’s estimated that around 1,500 surgeries each year end with an RSI. These patients often experience frequent infections, pain, bowel blockage, and other complications—and to add insult to injury, patients then need to be operated on again to remove the RSI. 

To combat the problem, the Association of periOperative Registered Nurses (AORN) released updates to its Guideline for Prevention of Retained Surgical Items back in 2016. Using a new evidence review model, the updated guidelines underscore the importance of clear communication and strong counting procedures to prevent the occurrence of RSI. 

The most notable update to the guidelines is the inclusion of a new evidence rating model that is based on the Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines. Each recommendation includes an assigned score based on an independent evaluation of all relevant research.

For example, recommendations assigned an appraisal score of "1" signify strong supporting evidence and a regulatory requirement. Those assigned a "5" have weaker evidence, or "benefits balanced with harms," according to AORN. It's an approach that is often used by other health organizations such as the CDC, which adds more weight to the updated recommendations, says Ramona Conner, MSN, RN, CNOR, editor in chief of the AORN guidelines.

"We've always included and discussed evidence in the literature, but we have a more formal way of doing that now," she says, noting that the guideline includes 222 supporting references. "There's quite a bit more information related to evidence that supports the recommendations in this new version."

 

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