JBI Brasil SIIES 2019 – I Simpósio Internacional de Implementação de Evidências em Saúde (SIIES)

Abstract
Introduction: Counting of accountable items used during surgery, frequently called the count is a fundamental practice ensure that items such as surgical instruments, sponges and sharps are not forgotten inside in the patients.1 Although inadvertently leaving behind a sponge or instrument at the end of an operation is a rare event, it is an error with serious implications. Literature reviews have shown that surgical counting is still not done ideally. In the service where the study was performed, there was no counting of needles and sharpers, only counting of compresses with low adhesion. Objectives: The aim of this evidence implementation project is to make a contribution to promoting evidence based practice in surgical counts in abdominal and pelvic open surgeries and thereby improve this surgical patient’s outcomes and resource utilization.
Methods: This evidence implementation project used the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit and feedback tool. The PACES and GRiP framework for promoting evidence based health care involves three phases of activity: 1. Establishing a team for the project and undertaking a baseline audit based on criteria informed by the evidence; 2. Reflecting on the results of the baseline audit and designing and implementing strategies to address non-compliance found in the baseline audit informed by the JBI GRiP framework; 3. Conducting a follow up audit to assess the outcomes of the interventions implemented to improve practice, and identify future practice issues to be addressed in subsequent audits. These three phases were performed over a period of six months, from August 2017 to March 2018. This project was submitted and approved by the institution’s Research Ethics Committee (CAAE number 79740517.1.0000.5208) and the audit has started after approval.
Results: The baseline audit revealed deficits between old practice and the best practice in all criteria. Barriers for implementation of a protocol for surgical counts were identified, and the strategies were implemented. The post-implementation (follow-up) audit showed improvement in compliance to best practice in six of the audit criteria selected except in two criteria, a multidisciplinary team approach for decrease retained surgical items (RSI's) and limited staff hand-offs during operative procedures to ensure the same team is present for all counting episodes whenever.
Conclusions: Main achievements included substantial increases in compliance with best pratices, with more positive results in the involvement of the nursing team. However, patency registration, notification and commitment for all surgical team to apply the entire protocol, not taking any step, continued to be a struggle.