Failure to account for all sponges, sharps, and instruments postoperatively may lead to the inadvertent retention of a foreign object. The retention of a foreign object may cause serious patient harm and often requires further medical treatment. Surgeons and operating teams routinely rely on the practice of a sponge, sharp, and instrument count to reduce the risk of a retained foreign object. Surgical counts are intended to prevent the retention of a sponge, sharp, or instrument, yet despite the highly regulated nature of the process, discrepancies in the surgical count occur. In 2008, the Pennsylvania Patient Safety Authority received 2,228 reports involving an incorrect sponge, sharp, or instrument count. The Authority also received 194 reports of retained foreign objects (RFOs). Preventing RFOs requires a multipronged strategy, including reliable counting methods. However, counting alone may be insufficient. This article examines risk factors for RFOs following surgery and addresses the role of human factors analysis to uncover system vulnerabilities. Risk reduction strategies include improved perioperative processes, perioperative team communication, and the use of assistive technology.
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