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Surgical Count Audit
Surgical Count Audit
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Created by Qualaris Staff
Critical Access Hospital
Operating Room
Table of Contents
Audit Form
Audit Form
Surgical Count Audit
Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Surgical Count Audit Checklist
Mark all as...
All counts completed by both the circulator and scrub before patient enters the room
Yes
No
Count performed in a systematic manner according to count sheet
Yes
No
Items added during procedure are added to the count sheet
Yes
No
N/A
Circulator documents each item on count sheet
Yes
No
N/A
Count is performed during closure of a cavity
Yes
No
N/A
Count is performed before wound closure begins
Yes
No
N/A
All counted items remain in OR until final count verified
Yes
No
Only radiopaque sponges on surgical field
Yes
No
Sponges are separated, counted audibly, and viewed by both circulator and scrub
Yes
No
N/A
Discarded sponges are placed in a leakproof receptacle that is easily visible to the team members who are counting
Yes
No
N/A
Sharps that have become broken must have all the parts accounted for and verified
Yes
No
N/A
Instruments that have extra pieces are accounted for separately on the count sheet
Yes
No
N/A
Broken instruments must have all the parts accounted for and verified
Yes
No
N/A
If count incorrect, it is reported to surgical team what is missing
Yes
No
N/A
If missing item found, count repeated, and verified
Yes
No
N/A
Xray completed for missing item
Yes
No
N/A
Incident reported per policy
Yes
No
N/A
