The Case of the Missing Sponge

Learning to scrub in the OR was a major task for me.

For those of you that are not familiar with the roles in the OR, I have attached these links for your reference. At the end of this document.

There are things I call OR Games that reflect some of the relational issues that occur in the surgical setting. There can be long standing competitive relationships between the RN's and the technicians. the basis for this is unknown to me.

I had not been in the OR for very long but because we were a small facility RN's needed to be able to scrub to meet the staffing requirements.

the ORT assigned to orient me was not happy with teaching a "new" person but as things were then, one did what the supervisor told you to do.

The basics were mastered and I finally got to pass instruments, I didn't perform too badly the first time. It was a basic hernia repair and really quite a simple procedure. When we were finishing as you do in all surgeries we counted. counting involves all sharps (knife blades, needles etc) and sponges. There was a missing sponge, We looked everywhere, the circulator went through the trash, the surgeon true to form informed us we needed to get our act together because there was no way there was a sponge left in the patient.

I was absolutely beside myself, we did one last count and lo and behold LaCretia (my preceptor) found it. I was elated. I did puzzle for some hours about what had happened, but went on to other cases without event,

This scenario repeated itself again and again ( only when LaCretia was present) and I began to doubt my skills, the big clue came one morning when we were setting up our table and I realized I needed an extra instrument on my mayo tray. For some reason I picked up the tray and lo and behold there was a clean folded sponge under the tray.

we did the case and of course at the end there was a missing sponge. We looked in the usual manner and then LaCretia declared, to all present," Chris will never get this right, she can't even keep her sponges straight. " I had been embarrassed over and over for this but this time I looked up at the surgeon and smiled. "I know where the sponge is, it is right here under the tray, where it was put. No doubt to be used at the end of the case, isn't that right LaCretia"

The room was quiet and LaCretia replied "my goodness, yes it is to clean up the patient, I plumb forgot that I put it there"

This game was over, it is only one of many and hopefully I will be more entertaining with future entries. I am hoping that I will have help from other OR people and more of their stories to share.





http://www.aorn.org/docs/assets/2092D890-1871-EBA3-88A5F41706EECF5E/RN%20Circulator%202008-2009%20Brochure.pdf

http://www.aorn.org/docs/assets/1CB4985E-1F29-E23E-B8EDD74AFF172420/FAQs.pdf

Basically the breakdown is that the RN circulator(circulator must be an RN) is in charge of the surgical suite operations. This RN is the controller if you want a simple definition.

The scrub role can be performed by an RN, Surgical Technician or several other trained roles. This position is the person that sets up the instruments that are required to perform the surgery. They then hand (pass the instruments to the surgeon to perform the surgery), this requires concentration, knowledge of the surgery and instruments.