Promoting Women's Health: One Sponge at a Time
- Discuss implications of the Joint Commission statement on Retained Foreign Object to current practice in Labor & Delivery.
- Develop a vaginal sponge count policy.
- Identify and implement a process designed to prevent unintentional retention of a foreign object in a patient undergoing a vaginal delivery.
The nurses at Baylor University Medical Center identified an improvement area promoting the health and safety of patients. In 2005, Joint Commission added unintended retention of foreign objects (RFOs) in patients after surgery or other procedure as a reviewable sentinel event. A need was recognized to create best practice for prevention of unintended RFOs during a vaginal delivery. A policy was developed and implemented in vaginal deliveries creating a safer environment.
Proposed change:
Nurses developed a process designed to prevent the unintended retention of a foreign object in a patient undergoing a vaginal delivery. Implementation steps included establishing a policy for vaginal count in Labor & Delivery, changing current charting system to include vaginal counts, and educating/training all staff.
Implementation, outcomes and evaluation:
The process began by recognizing the need to promote patient safety in women’s health, prevent unintended retained foreign objects during vaginal deliveries and to provide an accurate count of sponges and/or needles used before/after vaginal deliveries. A preliminary policy was developed for RFO prevention in vaginal deliveries. This policy was presented to a select group of physicians willing to participate and champion a pilot study. Basic changes to the charting package were made, and education was rolled out to the nursing staff. A four week pilot study was implemented. Utilizing results from the pilot study, additional changes to the charting system were made and the vaginal sponge count policy was finalized and adapted by the Baylor Health Care System. Random audits continue to take place to help identify process improvements or changes.
Implications for nursing practice:
Nursing’s involvement started at inception of this project to current implementation. The pilot study incorporated nurses participating in the counting process at delivery. Suggestions from staff helped to fine tune the process and lead to policy development. As with any change process, we had challenges implementing vaginal sponge counts at our facility. Counting in a vaginal delivery was foreign to most of our staff. To explain the importance of this process we equated it to counts in the operating room. Once we had staff buy-in, staff led the changes that occurred in our documentation system and policy development/implementation. They also participated in the audit process during our trial. Although counting in the delivery room did not increase workload, it was a process change for nurses and physicians. Staff input helped to balance patient safety with practicality and efficiency.
