Start/Search | Browse by Day | Author Index

Preventing patient injury as a result of a retained sharp/sponge/instrument, ongoing evaluation of hospital practice standards with the purpose to improve practice and patient outcomes must occur on a routine schedule. During a review of our hospitals Sponge, Sharp and Instrument Count Policy, it was identified that a communication system needed to be developed for the severely injured unstable surgical patient who required abdominal packing, known as damage control surgery; and needing immediate transfer to a surgical trauma intensive unit for stabilization. Damage control surgery has had a major impact on the survival rate in the severely injured trauma patient especially one who has sustained a life threatening injury such as liver rupture. Although damage control surgery continues to be a mainstay in trauma surgery, its use in the obstetrical population within our institution has become a standard of care when the unexpected occurs in the Obstetrical operating room. Damage control surgery has had a direct impact on the survival of patients with unexpected outcomes in both HELLP Syndrome and Hepatitis C who experienced a liver rupture as well as the unstable surgical amniotic emboli patient.

Evidence suggests that abdominal packing and a staged repair of both hepatic and retroperitoneal injury was more effective if instituted early as part of the resuscitative efforts in the management and prevention of the lethal triad of hypothermia, acidosis, and coagulopathy. Since the time to reoperation varies between 8 hours and 10 days, a team of operating room nurses, intensive care nurses and obstetrical nurses developed a patient safety process to prevent retained sponge(s) following damage control surgery. Communication between the OB unit, Surgical Intensive Care Unit and Operating Unit is a critical safety factor that needs to be initiated from whence the damage control surgery begins the packing procedure to the final operative procedure and removal of packing.

The team decided that when a patient has damage control surgery a pink bracelet is applied and will alert the ICU bedside nurse that the patient has abdominal packing and a packing log is in her chart to be used when packing is removed or when packing is added. The presentation will discuss the development the packing log process to prevent retained sponges following damage control surgery in the obstetrical patient. Included in the presentation will be three OB patient scenarios where favorable outcomes depended on damage control surgery and communication between disciplines.