October 1, 2016
The following statement was revised by the American College of Surgeons (ACS) Committee on Perioperative Care and was reviewed and approved by the ACS Board of Regents at its June 2016 meeting.
The ACS recognizes patient safety as an issue of the highest priority and strongly urges individual hospitals and health care organizations to take all reasonable measures to prevent the unintended retention of surgical items in the surgical wound.
Surgical procedures take place within a system of perioperative care composed of surgeons, perioperative registered nurses, surgical technologists, and anesthesia professionals. These health care providers share a common ethical, legal, and moral responsibility to promote an optimal patient outcome.
Prevention of unintentionally retained surgical items after surgery requires good communication among perioperative personnel and the consistent application of reliable and standardized processes of care.
Therefore the ACS recommends the following guidelines that can be adapted to various practice settings, including traditional operating rooms (OR), ambulatory surgery centers, surgeons’ offices, and other areas where operative and invasive procedures are performed:
The ACS also endorses the National Quality Forum’s definition of “end of surgery” as the moment “…after all incisions or procedural access routes have been closed in their entirety, device(s) such as probes or instruments have been removed, and, if relevant, final surgical counts confirming accuracy of counts and resolving any discrepancies have concluded and the patient has been taken from the operating/procedure room,” where applicable.
The ACS offers this statement for consideration by surgeons, their hospitals, and health care organizations. This statement is provided as general guidance. It does not constitute a standard of care and is not intended to replace the professional judgment of the surgeon or health care administrator. This statement may be reviewed and modified as necessary to conform with the laws of the applicable jurisdiction, the circumstances of the individual hospital and health care organization, and requirements of other allied and health care organizations.
Cima RR, Kollengode A, Storsveen AS, et al. A multidisciplinary team approach to retained foreign objects. Jt Comm J Qual Patient Saf. 2009;35(3):123-132.
National Quality Forum. Serious Reportable Events in Healthcare–2011 Update: A Consensus Report. Washington, DC. Available at: www.qualityforum.org/Publications/2011/12/SRE_2011_Final_Report.aspx. Accessed August 15, 2016.
Recommended practices for prevention of retained surgical items. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:305-321.