Given the costs of defense and the challenge to defend lawsuits involving RSI, preventing them from occurring at all is the best solution. Despite standards, policies, and procedures for sponge counting, failure to accurately count remains an error today (Jt Comm J Qual Patient Saf 2011; 37:51-8). For this reason, many institutions have begun to use various technology and software to aid in sponge counting and detecting RSIs. Radio-opaque materials and radio-frequency ID systems are being put in place to make counts more reliable. In fact, one Massachusetts insurer has funded the adoption of sponge-counting technology for its 11 hospitals.
RSIs are more likely to occur with emergency surgery, unplanned change in the operation, higher body mass index, and blood loss exceeding 500 mL (N Engl J Med 2003; 348:229-35; Int J Acad Med 2016; 2:5-21). Practices to aid in preventing RSIs from occurring include avoiding change of staff in the middle of procedures and improving communication among the surgical team. Any staff member in the operative suite should feel comfortable and empowered to speak up if there is any concern for an incorrect count or an RSI. Additionally, inspection of surgical instruments before and after use to check for breakage and the potential of device fragments should be routinized. Practices of methodical wound exploration have been recommended by The Joint Commission as well (bit.ly/PreventingRSI).
RSIs, though termed “never events,” continue to occur in health care today. They are associated with significant economic burden and a high likelihood for a civil lawsuit. Moreover, they are very difficult to defend, hence the aforementioned indemnity statistics. Employment of good perioperative practice among doctors, nurses, surgical techs, and all others is fundamental to prevention of these errors, and the use of sponge-counting technology is gaining ground. By making proactive and appropriate efforts around operating room procedures, you may avoid becoming a defendant in a lawsuit involving RSI.
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