The circulating nurse and scrub technician complete the closing count for a laparotomy and find one surgical sponge is unaccounted for. The surgeon states the wound looks clear and wants to close. What should the circulating nurse do?
- A.Accept the surgeon's visual assessment and proceed with closing
- B.Document the discrepancy and notify the charge nurse after the case closes
- C.Inform the surgeon of the discrepancy, request an X-ray before closing, and complete an incident report
- D.Recount the sponges twice more; if still discrepant, close without notification
Show answer & rationale
Correct answer
C. Inform the surgeon of the discrepancy, request an X-ray before closing, and complete an incident report
Rationale
C is correct: A discrepant sponge count is a patient safety emergency requiring immediate action. The surgeon must be informed, an intraoperative X-ray is required (per AORN and most institutional protocols) to locate the missing sponge before wound closure, and an incident/occurrence report must be completed. Patient safety supersedes the surgeon's desire to proceed. A is incorrect: Visual inspection is insufficient; retained surgical items can be hidden in tissue folds. Nurse-patient advocacy requires insisting on the X-ray. B is incorrect: Documenting after the case closes allows the patient to leave the OR with a potentially retained item. Notification must be immediate. D is incorrect: Closing with a known discrepancy without X-ray confirmation is a serious breach of surgical safety standards and could constitute negligence.
Key concepts