Circulating Nurse Role

The circulating nurse needs to notify the surgical team and arrange for an X-ray, if the patient’s condition permits, at the end of the procedure BEFORE the patient leaves the OR.

If the surgeon declines an X-ray, the circulating nurse must document that in accordance with the institution’s policies and procedures. In addition, a safety report must be prepared and documented.

The reason for the initial count not being performed must also be documented in the perioperative record, along with what actions were taken at the end of the procedure.

(ORNAC, 2021)

📁 Documentation Highlights

It is recommended that standard pre-printed count sheet/records be used to facilitate the surgical count. During the initial count, the circulating nurse must document the number of items as they are counted to ensure accuracy.

As the responsibility for the count falls upon the circulating nurse and scrub personnel, the counts must be signed according to the institutional policy.

The circulating nurse must also document the patient’s intraoperative record, as well as how many counts were performed and by whom. The circulating nurse must also document the outcome of the counts.

When items are added to the count during the procedure, they must be documented as soon as possible to prevent errors or missed surgical items. Each institution has a standardized method of identifying added surgical items after the initial count has been completed.

(Phillips, 2020 & AORN, 2022)

(ORNAC, 2021 & Phillips, 2020, AORN, 2022)

Incorrect Count/Count Discrepancy

Every healthcare institution has a policy/procedure outlining the actions required for an incorrect count.

These include the following steps:

1. The surgeon should be notified immediately, and they should pause their closure.
2. The count must be repeated.
3. The surgical team must examine the wound for any missing item.
4. The scrub nurse must search sterile tables, drapes, and the sterile field/mayo stand.
5. The circulating nurse must search the floor, garbage, and linen areas.
6. Charge nurses should be called to make them aware of the potential delay and to assist in the search.
7. After all search strategies have been exhausted, in communication with the surgeon, the circulating nurse must arrange for an X-ray prior to the patient leaving the OR, if patient status permits. In some cases, the surgeon may complete the closure first, but if an item is seen on the X-ray, the wound must be re-opened. Alternatively, the surgeon may request a portable X-ray and wait for the results before restarting the wound closure.
8. The circulating nurse documents the X-ray findings, as well as who read and cleared it.
9. The circulating nurse also documents measures taken to locate the missing item(s).
10. A safety report also needs to be created to record all the efforts made to find the missing item and the X-ray results.