two surgeons share a continuing responsibil- ity for these exceptions to the hospital’s im- plied instrument count policy.

When a surgeon is closing a patient Q quickly and the nurses doing counts cannot adequately complete a total count, do

What if the surgeon doesn’t want counts?

When a surgeon says: “No Q necessary,” can operating room nurses document this in writing and thereby be legally correct in the event that a sponge, instrument, or needle is not retrieved in surgery?

Yes, the procedure described is legally A correct (written documentation) and the pretrial statement or trial testimony of count nurses that they conformed to the “no count” order of the operating surgeon would be le- gally sufficient as a defense argument to demonstrate their disassociation with any liability arising out of that surgical order.

Two surgeons at my hospital have Q signed statements that they do not de- sire instrument counts on their cases. The hospital has a policy requiring such counts. Is the hospital (and its salaried operating room nursing personnel) protected by the signed statements of these two surgeons in the event that an instrument is left in a pa- tient’s body following surgery?

William A Regan, JD

The AORN Journal is pleased to announce a new monthly column on OR nursing law by William Andrew Regan, JD, managing part- ner, Regan, Carberry & Flynn, Providence, RI.

If you have questions on OR nursing law you would like to have answered, please send to William A Regan, JD, c/o AORN Journal, 10170 E Mississippi Ave, Denver, Colo 80231. Questions of general interest will be selected for replies in this column. Other questions will not be answered. Ques- tions will not be acknowledged or returned.

If the medical administration and gen- A era1 administration have accepted the statements of these two surgeons indicating that they do not desire instrument counts, the operating room nurses should have no The AORN “Standards for sponge, needle, and further concerns about their personal prOfeS- instrument procedures” appears in the May 1976 sional liability. However, the hospital and the AORN Journal, p 971.

AORN Journal, October 1976, Vol24, NO 4 619

the nurses have a legal right to insist that the surgeon slow down to permit the nurses to properly finish their counting process?

The answer depends on the reasons A for the surgeon’s speed in closing his patient. When speed in closing is dictated by the patient’s respiratory distress or deteriorat- ing physical condition, the surgeon’s decision overrides all other considerations. However, when speed is simply the technique of a particular surgeon and when it is excessive to the point of interfering with the separate professional responsibilities of the operating room nurses, the matter should be resolved between the OR nursing supervisor and the errant physician. If that fails to correct the problem, the OR supervisor should take the matter up with the physician in charge of the department or his designee for this purpose.

Who is directly responsible for estab- Q lishing a hospital policy on instrument and needle counts?

The director of surgery or the OR A committee ordinarily headed by the physician in charge of surgery is responsible for making a policy determinination as to whether or not there will be mandatory in- strument and needle counts during surgery. This is a responsibility appropriately dele- gated to it by the executive committee of the medical staff. Such a policy should conform to the AORN standards for instrument and needle counts. Once such a policy has been established, the procedures designed to in- sure the implementation of that policy should be formulated by the department of surgery and the nursing service department of the hospital.

May an OR technician have any legal Q responsibility for sponge, needle, and/or instrument counts?

While a technican can be legally re- A sponsible, appropriate and consistent with AORN standards, the technician should only serve as an assistant to the registered nurse in sponge, needle, and instrument counts.

If the sponge count is done by one Q person, usually a licensed practical nurse or OR technician, and the OR super- visor is aware of the AORN standards for

sponge counts, what is the liability of the OR supervisor?

The OR supervisor, noting the person- A nel deficiency in sponge counting, should immediately make arrangements for coverage, meeting the AORN standards (re- quiring that counts be done by two people- scrub and circulating nurses-ne being an RN). When she is prevented from doing so by budget constraints or administrative pol- icy, she should insist upon a waiver of budget limits and an exception to administra- tive policy to get adequate staffing to con- form to AORN standards. Courts throughout this nation recognize the role of AORN in setting qualitative and quantitative standards. Hospitals everywhere would be well advised to conform to AORN standards.

What is the responsibility of the OR Q supervisor in a hospital operating room suite where the ratio of OR technicians to RNs is 9:1?

When an experienced OR supervisor is A aware of any patient care situation in her department that is potentially dangerous to the health and safety of the patients who will use that facility, she should bring her concerns to the attention of those in her hospital who are in a position to rectify the potentially dangerous situation. Once she has done so and has documented that fact in a memo or in her personal log or in some other appropriate manner, it then becomes the duty of hospital management to rectify the situation and eliminate the danger. The American College of Surgeons and AORN recommend a 1 to 1 on duty ratio of techni- cians to registered nurse.

What is the responsibility of the OR Q supervisor when written hospital policy dictates that OR technicians may circulate?

Written hospital policy that permits OR A technicians to circulate is inconsistent with established regulations of both federal and state governments and exemplary hospi- tals throughout the nation. Circulators should be registered nurses. The role of the techni- cian in relationship to the OR should be in a support position, not as a circulator.

William A Regan, JD

620 AORN Journul, October 1976, Vol24 , No 4