BHAFPX4010_HanksSteven_Assessment4_Attempt2
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Jan 9, 2024
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Steven Hanks
BHA_FPX4010: Intro to Health Care Research
Capella University
Dr. Michael Furukawa
October 10th, 2023
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Problem Statement
Nearly 28 million surgeries are performed every year and out of that 28 million, roughly
1,500 surgeries end with a retained surgical object.
Surgery is a challenging and intense thing a doctor provides, and the risk of retaining a
surgical object is there, especially in trauma patients. Retained objects can cause significant harm
such as impairment, disability and even death and roughly 80% of surgeries that have a retained
object are declared “clear or correct” for the instrument count. Research shows that patients with
a larger body mass index, intraoperative complications and unexpected events are more at risk
for retaining a surgical object. Clear signs of this error are usually a breakdown in
communication, an important factor when dealing with a delicate matter like surgery
(Zejnullahu, et al., 2017). In order to minimize this error from happening we need to ensure clear
communication is med to help reduce the harmful effects retained objects can and will have on
patients.
Purpose Statement
The intended outcome of this research is to help reduce and possibly eliminate retained
surgical object errors from happening. According to Zejnullahu, et al., counts during surgery
should happen in this form – first a count should be done before the procedure/surgery begins,
whenever new items are introduced into the surgical area, before the surgeon closes the cavity,
when the surgeon begins to close the cavity and when the surgeon closes the skin (Zejnullahu, et
al., 2017). Five counts, with clear communication is needed to help prevent these errors. As
healthcare professionals it is our duty and job to provide excellent care for each patient that
walks through our doors, therefore, the desired outcome of this research is to develop a safety
model that provides staff a tool to help reduce surgical objects being left behind.
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Additionally, to help reduce retained objects during surgery, Pyrek (2017) recommends
that hospital surgery departments and others should introduce to staff more secure and
safeguarded practices that help locate, identify and isolate weakness throughout the surgical team
routines. Are they taking enough time outs? Are they fatigued? Both the problem and purpose
statements go hand-in-hand as they both focus on the importance of identifying the issue within
operating rooms and aids in offering an approach to correct the problem.
Researching evidenced based methods provide reliable and dependable opportunities for
changes to be implemented. For example, the World Health Organization implemented a surgical
safety checklist. This covers ensuring you have the correct patient before anesthesia is
introduced, to confirming all members of the team are there and completing surgical counts at
the end of the surgery (World Health Organization).
Qualitative Research Question
If correct procedures are followed before and after surgery is performed, why are retained
surgical objects still happening more each year?
Every year, in the United States, our health care system has seen an increase in retained
surgical objects. This can have detrimental effects on a hospital's reputation, increase the amount
of medical malpractice suits and put the patient in an unsafe environment (Pyrek, 2017).
Understanding and using qualitative research methods can help us gain a deeper understanding
of what the real reason retained objects are caused from. Is it truly a communication breakdown?
Lack of training? Qualitative research opens the door to an understanding of the problem and
helps us as researchers learn a solution to implement. Qualitative data also provides an
evaluation of the different perspectives such as from the surgeons, nurses and scrub techs (Choo,
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et al., 2015). Utilizing qualitative research requires an in depth understanding of the process and
organization of data to help researchers determine how one thing can affect another.
During research it would appear there are four different types of qualitative research, but
the most appropriate for the specific issue discussed would be Ethnographic Qualitative
Research. Ethnographic qualitative research is aimed to study a culture, group or organization by
studying them in their natural habitat, in this case the operating room (Kramer, et al., 2017).
Using this will give us an in depth look at interactions and behavior patterns within the operating
room which in turn should help us isolate the unfortunate event that leads to retained surgical
objects.
Data Collection, Reliability and Validity
The most reliable and effective method to use for data collection with this issue would be
observation. This method helps researchers determine and notice behaviors and events in a
natural setting. Observation can be overt (observation is known by all) or covert (observation in
secret). In our case, a covert observation would be the most beneficial as people who are
unaware of themselves being observed tend to act in a more natural state which in turn would
provide reliable results and outcomes. (Centers for Disease Control and Prevention, 2018).
Utilizing these methods, researchers can determine if the operating atmosphere is calm or tense,
and if procedures and rules are being followed as they should. Communication between staff can
also be observed as this helps determine where breakdowns could have been avoided and if
messages are understood clearly.
To determine the reliability of the data collection we would need to test and then retest
for consistencies and inconsistencies. The most common methods are the test-retest, internal
consistency methods and alternatives (Hasnida, et al., 2016). An example of this would be two
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always divides into even numbers or checking a thermometer in a temperature controlled
environment will always read the same. This will allow us to make reliable and sound
determinations to help reduce retained surgical objects in patients.
Additionally, validity determines how accurate or reliable a method measures or is
intended to measure something (Hasnida, et al., 2016). It is proven that research that has a high
level of validity ensures a result that goes hand-in-hand with characteristics in both the social and
physical world. Validity is shown as three different types – construct, content and criterion
(Hasnida, et al., 2016). Going back to our thermometer example, if the device reads a different
temperature in a controlled temperature room, then we can conclude the thermometer is
malfunctioning thus reducing validity.
When developing our fix to reduce surgically retained items, we must ensure we have a
reliable and valid research method to determine the best course of action. The last thing we want
as researchers is to recommend a method that increases the amount of object retained but instead
we want to reduce and maybe even eliminate the error.
Relation
The relation as a whole starts with deciding where the problem lies. A quality research
endeavor needs to first focus on a problem, in our case, retained surgical objects. We then jump
into figuring out how we can implement procedures or policies to help fix the issue at hand,
which would be increased communication and a specific way for surgical counts to be
conducted. Next, we need to look in depth at how staff are acting within the surgical
suites/operating rooms via observation. Essentially, you cannot develop a solid research plan
without first evaluating the issue, thinking of ways to fix it, observing the situation to determine
where errors are happening and finally developing a solid way to decrease the error from
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happening. Each piece of the plan fits together because you cannot have one without the others
and vice versa.
Conclusion
Retained surgical objects are more common than we think. Despite efforts made it truly is up to
the team that is in the operating room to ensure proper communication takes place to help ensure
a safe working environment for them and the patient. With open and clear communication
between all parties, we are likely to see a decrease in retained objects.
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References
Choo, E. K., Garro, A. C., Ranney, M. L., Meisel, Z. F., & Morrow Guthrie, K. (2015).
Qualitative Research in Emergency Care Part I: Research Principles and Common
Applications. Academic emergency medicine : official journal of the Society for
Academic Emergency Medicine, 22(9), 1096–1102.
https://doi.org/10.1111/acem.12736
Centers for Disease Control and Prevention. (2018). Data collection methods for program
evaluation: observation.
https://www.cdc.gov/healthyyouth/evaluation/pdf/brief16.pdf
Hasnida, N., & Ghazali, M. (2016). A Reliability and Validity of an Instrument to Evaluate the
School-Based Assessment System: A Pilot Study. International Journal of Evaluation and
Research in Education (IJERE), 5(2), 148–157.
https://files.eric.ed.gov/fulltext/EJ1108537.pdf
Kramer, M., & Adams, T. (Eds.) (2017). . (Vols. 1-4). SAGE Publications, Inc,
https://doi.org/10.4135/9781483381411
Pyrek, K. (2017, March 31). Preventing Retained Surgical Items is a Team Effort. Infection
Control Today.
https://www.infectioncontroltoday.com/view/preventing-retained-surgical-items-team-eff
ort
World Health Organization. (n.d.). World Health Organization Safe Surgery Saves Lives Starter
Kit for ...
https://cdn.who.int/media/docs/default-source/patient-safety/safe-surgery/starter_kit-sssl.
pdf?sfvrsn=9cef94b8_7
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Zejnullahu, V. A., Bicaj, B. X., Zejnullahu, V. A., & Hamza, A. R. (2017). Retained Surgical
Foreign Bodies after Surgery. Open access Macedonian journal of medical sciences, 5(1),
97–100.
https://doi.org/10.3889/oamjms.2017.005