Case One: An Open Hernia Repair

In practice

The night before, Morgan, the scrub person, reviews the surgeon's preference card. In the morning Morgan gathers supplies from the card, inspects each package before opening it, and checks each internal indicator. Morgan sets up the back table and the Mayo stand, opening only what the case needs. Morgan and the circulating nurse do the initial count aloud together, and the circulating nurse records it. The patient arrives and is identified, and placed supine with padding over pressure points. At the time out, everyone stops; the team confirms the patient, the procedure, the side, and the mesh implant that the surgeon plans to use. During the case, Morgan watches the field and passes each instrument so it arrives ready to use. The mesh is opened when the surgeon confirms the size, and its record is placed in the chart. Morgan keeps a needle counter on the field and accounts for each needle as it returns. Before closure, Morgan and the circulating nurse count aloud again, and the count is correct. The layers are closed and the final count is correct. At the sign-out, the team confirms the procedure, the counts, and that there are no equipment problems. Morgan contains the sharps, opens every hinged instrument, keeps the instruments moist, and closes the transport container. The circulating nurse gives the recovery nurse a full report, and the room is cleaned and disinfected for the next case.