A Sign-Out That Caught a Missing Needle

In practice

At the end of a long hernia repair, the circulating nurse starts the sign-out while the surgeon closes the skin. When she asks about the counts, the scrub person, Riley, pauses: the final needle count is one short. Earlier in the case, a needle had been reported dropped, and the circulating nurse had found and recorded it, but a second small needle from the same package is not in the needle counter. Riley says that the needle count is not reconciled. The surgeon stops before placing the last skin stitch. The team searches: the field, the drapes, the floor, the linen and the trash. Riley checks the needle counter and the suture packages, matching each package's marked number with the needles counted. The surgeon examines the wound. The needle is not found. Riley repeats the count with the circulating nurse, and it is still one short. The circulating nurse notifies the supervisor, and an X-ray is taken before the patient leaves the room. The image shows the small needle in the subcutaneous tissue near the incision. The surgeon reopens that part of the wound, removes the needle, and closes again; the closing count is repeated and is now correct. The circulating nurse documents the discrepancy, the search, the X-ray and the removal.