Development of Perioperative Nursing Guideline for Prevention of Retained Surgical Items, Rajavithi Hospital

Abstract

The quality surgical standards are required under effective guidelines to prevent the retained surgi-cal items which may cause complications resulting in physical and mental health as well as quality of life. This research and development aimed to (1) develop guidelines for prevention of retained surgical items in patients undergone surgery, (2) evaluate the guidelines implementation, and (3) study users’ satisfaction when implementing these preventive guidelines. The study was carried out in operating rooms at Rajavithi Hospital during June 2016 to March 2017. The PDCA process of Deming cycle and the Iowa model of evidence-based practice were applied to this study. The purposive sampling method was used to select two sample groups: 1) 72 registered nurses, 2) 400 patients undergone surgery. The research instruments were comprised of 1) the developed preventive guidelines of retained surgical items, 2) an evaluation form of implementing the guidelines by an observation, and 3) a questionnaire of nurses’ satisfaction when implementing the guidelines. The data were analysed using descriptive statistics as percentage, mean, median, standard deviation, and range. Chi-square test was performed to compare the incidences of retained surgical items. The study result revealed that the development of guidelines for preventing retained surgical items were consisted of five categories: (1) a guideline of sponge count, (2) a guideline of sharp count, (3) a guideline of instrument count, (4) a guideline for recording sponge, sharp, and instrument count, and (5) a guideline for handling miscounted items. The evaluation of implementing these guidelines indicated that incidents of retained surgical item decreased significantly of 4 vs 0 cases (p-value = 0.038). The overall satisfaction of the users was rated at the high and highest level (94.5 – 98.6%). Therefore, these developed guidelines were considered as a quality surgical standard which can be used to prevent retained surgical items in patients. The perioperative nursing department in tertiary care hospitals should apply the guidelines and continually evaluate for its maximised proficiency.