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Implementing “NoThing Left Behind®”: Reducing the Incidence of Foreign Bodies after Surgery

What are we looking to improve?
Surgical teams work with varying numbers of instruments, needles, sponges and other items during operations, making it critical to have a system that ensures that none is left inside a patient cavity. Through our initiative, we want to increase staff awareness and minimize errors in identifying and counting such items.

What strategies/measures have we implemented for improvement?
Mount Sinai Health System has adopted standards set by the Association of Perioperative Registered Nurses, and also developed our own best practices and shared them throughout our member hospitals. Interventions to date include:

  • “Time Out” before surgery, where the operating room team orally reviews the case and members introduce themselves and explain their roles in the procedure
  • The implementation of a white eraser board, which documents the numbers of instruments, sponges and needles before surgery and prior to closing, for all to see
  • The use of plastic, hanging sponge holders (similar to shoe bags) to deposit used sponges for accurate accounting

What have we accomplished to date?
Compliance has been tracked by staff assigned to observe surgeries. Additionally, the program has been expanded to OB operating rooms.

What are our future plans?
More strategies are forthcoming, and health care teams will present their cases to their peer groups.

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