Using bar-code technology to assist with counting

AORN Journal, July, 2008 by Pat Frasher, Denise Maxwell-Downing

After reading the answer to the question on counting sterile towels in the April 2008 Clinical Issues column, (1) I was disappointed that no information was included on the use of bar-code technology for counting gauze, laparotomy sponges, and towels. Your answer highlights only radio-frequency identification (RFID) as an acceptable solution to the patient safety issue of retained surgical sponges, citing a 2006 article in Archives of Surgery. (2) What is not stated is that this evaluation included only eight patients in a non-real patient care setting; therefore, it should not be misconstrued as a valid clinical study.

In April, Annals of Surgery published a study conducted at Brigham and Women's Hospital, Boston, Massachusetts, that compared the use of bar-code technology to use of the traditional counting protocol in 300 general surgery procedures using a randomized controlled design. (3) The study found that using bar-code technology in addition to counting detected significantly more sponge count discrepancies than counting alone (32 versus 13 discrepancies). These discrepancies included both misplaced and miscounted sponges.

I believe you have a responsibility to investigate and report on all available technologies when answering questions pertaining to patient safety in the perioperative patient care setting. This way, readers will receive unbiased, complete information.

PAT FRASHER

RN, BGS, CNOR, CRNFA

CLINICAL NURSE RNFA/PRIVATE SCRUB

ADVANCED ORTHOPEDICS CENTERS

RICHMOND, VA

AUTHOR'S RESPONSE. In this particular column, the member's question related to the use of non-radiopaque towels for abdominal packing and whether RFID tags would assist with locating a lost towel. The intent of the author's response was not to address all technological advances that perioperative personnel can use to detect retained foreign objects in surgical patients.

Although the sample size was small in the study cited, the eight patients underwent abdominal or pelvic surgery performed in a real surgical suite at Stanford University Medical Center, Stanford, California. (2) The column noted that "despite efforts to make the scanning device 100% accurate, the system is not fail-proof and user error can occur. (1(p85))

As you mentioned, RFID is only one option for detecting retained foreign objects. Thank you for describing another option.

REFERENCES

(1.) Downing D. Counting sterile towels [Clinical Issues]. AORN J. 2008;87(4):823-826.

(2.) Macario A, Morris D, Morris S. Initial clinical evaluation of a handheld device for detecting retained surgical gauze sponges using radio-frequency identification technology. Arch Surg. 2006;141 (7):659-662.

(3.) Greenberg CC, Diaz-Flores R, Lipsitz SR, et al. Barcoding surgical sponges to improve safety: a randomized controlled trial. Am1 Surg. 2008;247(4):612-616.

Editor's note: For a synopsis of the article on barcoding surgical sponges, see Evidence for Practice on page 121 in this Journal.

DENISE MAXWELL-DOWNING

RN, MS, CNOR

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE