A nurse-led approach to developing and implementing a collaborative count policy.

During the 2007 meeting of the Child Health Corporation of America Operating Room Director's Forum, members identified two major discrepancies in surgical count policies among the member hospitals: variations for instrument counts in pediatrics and exceptions to radiographic verification when needle counts were incorrect. The group agreed to collaboratively develop a pediatric count policy based on directors' expertise and current literature to help improve count practices. The task force members reviewed the literature as well as count policies from 30 member hospitals to identify and combine best practices and to create a single, standardized count policy. The project exemplifies a successful nurse-led, national group effort. The outcome is a policy that represents best practice in pediatrics and is a first step toward future opportunities to improve patient safety.

Patients count on it: an initiative to reduce incorrect counts and prevent retained surgical items.

Retained surgical items were the most frequently reported sentinel event in 2010, according to The Joint Commission. Perioperative nurse leaders at Children's Hospital Boston, a pediatric teaching hospital, conducted a quality improvement initiative to reduce or eliminate incorrect counts and count discrepancies, which increase the risk of an item being unintentionally retained after surgery. Work included educating the perioperative staff members, standardizing count practices, formally reviewing every reported count discrepancy with the nursing team, and reviewing and revising the count policy for prevention of retained surgical items. The initiative reduced the number of incorrect counts and count discrepancies by 50% between 2009 to 2010. These initiatives continue to be expanded, and the results have been sustained on an ongoing basis.

The evolution of a surgical liaison program in a children's hospital.

Surgical liaison nurses use clear communication to provide timely reports to family members about their loved one during the time the patient is in the OR. The surgical liaison program at the Children's Hospital Boston, Massachusetts, has evolved over time. It began as nurses supervising brief family member visits to the postanesthesia care unit (PACU) and has become a program in which surgical liaison nurses work with OR and PACU staff members to access and provide patient-specific information to families throughout the surgical time period and prepare families for extended visits to the PACU. In addition, we redesigned our surgical department by expanding its size, locating it closer to the OR and PACU, and providing more amenities to family members. A survey conducted to assess family member needs found that most people were satisfied with the services provided, and we were able to make improvements to services based on the survey feedback.