The impact of quality improvement interventions on compliance with standardised surgical count protocol and count discrepancies: A quality improvement study

Abstract

Background: This study was conducted to investigate the effect of implementing quality improvement interventions for counting surgical sponges on compliance with the Association of periOperative Registered Nurses (AORN) surgical count protocol and occurrence of count discrepancies.

Method: An interventional quality improvement project from 1 February to 20 September 2022. Thirty perioperative nurses and surgical technologists participated 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.