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Association of Perioperative Registered Nurses (AORN) recommended practice for sponge, sharp and instrument counts provides guidance to the perioperative nurse to account for all items and lessen the potential for injury from a retained item. A complete and accurate counting procedure helps to promote optimal patient outcomes and demonstrates a commitment to patient safety. Legislation does not propose who, how, or when therefore all team members should be committed to and involved in establishing a count policy and procedure

The literature identifies Obstetric and Gynecological procedures to be the most common operations associated with a retained surgical sponge or instrument. Extracted from a review of surgical sponge legal claims, 11 out of 40 cases followed a vaginal delivery with total indemnity payments exceeding $5,000,000.

Postpartum patients present to their primary care provider (PCP) or to OB/GYN Triage with the similar complaint of foul smelling vaginal discharge when upon vaginal exam a putrid 4 × 4 was found left behind after repair of a vaginal or cervical laceration. Despite the rarity of the reporting of a retained vaginal sponge, the occurrence appears to be encountered more commonly than generally is appreciated. LDR teams should ensure that sponges and needles be counted at all vaginal deliveries, as the risk for a retained foreign object is present. In addition, the PCP should not unquestioningly accept correct count reports, but develop the habit of visualizing and documenting the count procedure.

Since human performance is as variable as the errors it produces, our unit practice standards were re-evaluated. In 2008, as a patient safety initiative, our LDR unit adopted the Sponge, Sharp and Instrument Count Procedure utilized in the OB operating room for all vaginal deliveries and included a witnessed count between the LDR nurse and PCP. Counts are then documented on a pre-formatted dry erase board for visibility and improved communication among team members. Upon completion of the delivery, the PCP and LDR nurse document count correctness on the Count Record located in the patient's medical record.

As part of the practice change, a chart review by the LDR Performance Improvement Council (PI) was completed and it was identified that nursing was 100% compliant for signature and count documentation correctness while the primary care provider was 63% compliant for signature documentation correctness.

The PI Team met with the PCPs to discuss barriers to signature documentation of count correctness for vaginal deliveries. Recommendations to improve PCP signature documentation were then presented for review and approval by hospital wide committees to ensure compliance with the present Count Policy. Once the recommended changes were approved and implemented the PCP's documentation of count correctness and signature compliance achieved 100 percent.

The presentation will include aspects of our Sponge, Sharp and Instrument Count Policy that improves communication among providers, identified barriers to PCP documentation and the initiative to improve documentation. Since the PI Council identified barriers to PCP documentation, the ongoing evaluation of unit practice standards with the purpose to improve practice and patient outcomes must be encouraged.