AORN Blog - The Periop Life

How to Overcome Barriers Incorporating Adjunct Technology

Overcoming Technology Barriers
April 25, 2021

Valerie March
Dr. Valerie Marsh, University of Michigan School of Nursing - Clinical Assistant Professor

Dr. Valerie Marsh is no stranger to the objections OR managers face when they recommend the use of adjunct technology in the counting process. Now a perioperative education specialist/nursing supervisor at Michigan Medicine, she recently transitioned to the School of Nursing as a clinical assistant professor. Marsh has practiced as a perioperative nurse for the past 40 years.

Marsh shared her experience and expertise on how to best incorporate adjunct technology in a recent interview. Specifically, she focuses on some of the common barriers and perceptions regarding the technology as well as tips for overcoming them.


What are the opposing views around adding adjunct technology?

Patient safety, high-quality care and positive patient outcomes are the responsibility of every healthcare provider. When we implemented the SurgiCount technology, we got a lot of pushback from staff and surgeons, who said it took too long to scan the sponges in and out of the cases.

OR complaints that the process of doing a two-person manual count and using the SurgiCount Scanner seemed redundant. The pushback was short-lived when the mindset went from adding to the workload to providing safe patient care. A study by the Mayo Clinic provided data that supported the use of Data Matrix Technology for sponge counting after four cases went from 11 seconds to four seconds.(1) The article stated that the total time to count sponges did go up, but the surgical time went down, this accounts for the reduction of OR time by seven seconds.

Why are there opposing views on this subject?

Nurses have been doing two-person manual counts for as long as I can remember, because the incident of RSS is rare (1 in every 8,000 to 18,000 inpatient surgeries) (1), there is an attitude of "That would never happen to me."

Marsh, Kalish, McLaughlin et al. (2020) sent a survey to over 5,000 AORN members, over 1693 surveys met the criteria and were used for data collection. We surveyed OR nurses' perceptions of missed nursing care before, during, and at the end of surgery, prior to the patient leaving the OR. We found that 42 nurses (2.5%) did not communicate a count discrepancy to the surgeon, and 177 nurses (10. %) did not verify that the surgical count was correct during the closing count (2). The use of [adjunct technology] for all cases is imperative to prevent retained surgical sponges because of human factor errors, poor communication during the final closing count, and disruptions in the OR. This study provides data regarding what is missed and how often. In this case, one RSS is one too many.

What would your advice be to them?

First, any Data Matrix Technology (DMT) can save time in the OR when policy and standard work are followed. Before implementing any new technology and products, or changing policies, surgeons and staff need to have a place at the table and be part of the decisions that impact their work, like DMT.

Secondly, the OR is becoming more complex with equipment, instrumentation, video recordings, and disruptions like pagers and cell phones; therefore, trying to concentrate on counting manually has become more challenging. After a decision is made to purchase adjunct technology, education is necessary and staff needs to be comfortable with the new technology, they need to follow policy, and understand the importance of not creating workarounds.

Finally, I would look at a study by the Mayo clinic (2009-2010) when they reviewed DMT's and found the number of cases completed over 18 months at three different sites was 87,404. There were 1,862,373 sponges used during these cases, and there was not one single retained sponge (1). My advice is to have an open mind regarding your ability to count during a complicated case, multiple disruptions, and handing off your patient to an oncoming nurse at the end of a long day. Consider the benefits of using DMT to keep the patients free from RSS. Marsh stresses the importance of being open to new technology that focuses on patient safety; no matter how challenging it can be to change your practice. In the end, it’s about patient safety and reducing RSS incidents in the OR.

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  1. Cima, R, Kollengode, A., Clark, J. Pool. S., Weisbrod, C., Amstutz, G.J., Deschamps, C. Using a Data-Matrix-Coded Sponge Counting System Across a Surgical Practice: Impact After 18 Months. The Joint Commission Feb;37 (2)
  2. Marsh, V., Kalisch, B., McLaughlin, M., Nguyen, L. Nurses' Perceptions of the Extent and Type of Missed Nursing Perioperative Nursing Care. AORN.2020 September;112 (3):237-247
Michigan Medicine's results reflects the policies and protocols implement by MM and the results are not necessarily representative of what another hospital may experience. Dr. Marsh may have or have had a financial or advisory relationship with Stryker.

This blog content was created in partnership with Stryker.

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