a credentialing requirement and essential compo-

nent in the twice yearly mandatory education of

the nursing sta¡. Examples of the simulations con-

ducted over the past year include shoulder

dystocia, postpartum hemorrhage, emergency Ce-

sarean birth, neonatal resuscitation, and high-

spinal drills. Improvements in shoulder dystocia out-

comes have been documented. This presentation

introduces the three components of simulation: pre-

brief, simulation practice, and debrief; discusses

the strategies involved in this training technique;

provides examples of its use in the practice setting;

and shares low-cost tools and approaches for the

participants to use in their own institutions.

When Counts Count: Improving Practice

and Documentation

Poster Presentation

The Association of Perioperative Registered

Nurses 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 demon-

strates a commitment to patient safety. Legislation

does not propose who, how, or when counts are

conducted, therefore, all team members should be

committed to and involved in establishing a count

policy and procedure

The literature identi¢es obstetric and gynecological

procedures to be the most common operations as-

sociated 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 ex-

ceeding $5,000,000. Despite the rarity of the

reporting of a retained vaginal sponge, the occur-

rence appears to be encountered more commonly

than generally is appreciated. Labor and Delivery

room (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 primary care provider (PCP) should

not unquestioningly accept count reports but

should develop the habit of visualizing and docu-

menting the count procedure.

Because human performance is as variable

as the errors it produces, our unit practice stan-

dards were reevaluated. 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 preformatted dry erase board for visibility

and improved communication among team mem-

bers. 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 (PI) Council was

completed, and it was identi¢ed that the nurse was

100% compliant for signature and count documen-

tation correctness while the primary care provider

was 63% compliant for signature documentation

correctness.

The PI Teammet 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%.

The presentation includes aspects of our Sponge,

Sharp and Instrument Count Policy that improves

communication among providers, identi¢ed barri-

ers to PCP documentation, and the initiative to

improve documentation. Because the PI Council

identi¢ed barriers to PCP documentation, the on-

going evaluation of unit practice standards with the

purpose to improve practice and patient outcomes

must be encouraged.

Christine Townsend, RNC,

Women’s and Children’s Ser-

vices, Christiana Care Health

Care Services, Newark, DE

Nancy Skinner, MSN, RNC,

Women’s and Children’s Ser-

vices, Christiana Care Health

Care Services, Newark, DE

ProfessionalIssues

S82 JOGNN, 39, S48-S84; 2010. DOI: 10.1111/j.1552-6909.2010.01121.x http://jognn.awhonn.org

I N N O V A T I V E P R O G R A M S

Proceedings of the 2010 AWHONN Annual Convention