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Being a nurse at a major hospital means that I work hard and have a lot of responsibility, patient care is something that the nursing profession takes very seriously and being a theatre nurse means that I get to be also responsible for the medical instruments that are used in theatre by the doctors.p
Looking after the medical instruments can be a little daunting and sometimes things can go wrong and have done in the past so we have procedures these days to account for all of the medical instruments before and after a procedure – you will understand why once I tell you this story.
It is not about me but a nurse friend of mine Jane who used to work in theatre a few years ago and then it was her job to look after the medical instruments. This involved preparing them before every operation making sure that they were sterilized and ready to be used.
Well Jane was a bit of a nervy type and at the time she was having some issues at home with her children being sick so she was tired from a lack of sleep and probably not concentrating as much as she normally would have. Normally she would have counted the medical instruments after the operation but this time she didn’t because it was the end of her shift and she wanted to get home in a hurry to see how her kids were.
The operation had been a fairly routine one and Jane had prepared the medical instruments before hand, the patient’s appendix had been removed successfully and the patient had been stitched and taken off to the recovery ward. Jane had left the operating theatre soon after, she had glanced quickly at the medical instruments and then left them with a junior nurse to clean as she left for the day to travel home to see her children.
The first sign that something may be amiss was when the junior nurse counted the medical instruments and there were two clamps missing but being a junior nurse she just thought that she had got it wrong and didn’t report that there seemed to be some medical instruments missing and went about the rest of her shift without a further thought.
When the patient later that evening complained of abdominal pain the nurse in charge, unaware of the missing medical instruments thought that the pain was just a symptom of the procedure that the patient had undergone that day so she made the patient comfortable and didn’t feel it necessary to call the doctor.
When the patient developed a fever in the middle of the night the nurse consulted with the doctor on call. Neither was aware of the missing medical instruments so he prescribed antibiotics and the nurse was asked to closely monitor the patient, as they were concerned about the onset of possible complications from the removal of the appendix that day.
In the meantime a senior nurse had counted all of the medical instruments and found that two clamps were missing knowing that this was unusual she started to check with the nurses that had worked in the operating theatre that day to ask them about the medical instruments.
She also checked with the patients early the next morning when the day shift had arrived and was suspicious when she heard about the patient with abdominal pain and asked Jane about the medical instruments. When Jane admitted that she hadn’t counted them and had left it to the junior nurse they then sought out that nurse to check about the medical instruments – not wanting to raise the alarm unnecessarily.
The junior nurse, when she saw the alarm on their faces, broke down in tears and told them that she had noticed that there were two clamps missing when she counted the medical instruments after the operation but hadn’t thought that she should tell anyone.
They next went to check the patient and found that they had deteriorated and were feverish so they consulted with the doctor who had performed the operation and told him about the missing medical instruments that two clamps were missing and they thought that just maybe they were left inside the patient when they were stitched up.
The doctor very concerned about his patient’s condition ordered an immediate x-ray to see if the medical instruments were in deed inside of the patient and the patient was wheeled off to see if they could find the source of her pain. While she was there they quickly established that the medical instruments, the two clamps had been mistakenly left inside the patient when the patient had been closed and were most likely causing the difficulty that the patient was experiencing.
They booked an operating theater and wheeled the patient straight there to retrieve the medical instruments and to relieve her symptoms - especially the pain that she was experiencing. The same doctor performed the operation and he was very embarrassed about the whole situation and took responsibility for the medical instruments being inside the patient, Jane still felt responsible.
The operation went well and the medical instruments were removed successfully from the patient. She experienced no further complications and went home a few days later when she was healing well. There was an investigation from the hospital and the result was that everyone needs to take responsibility for the medical instruments especially after an operation and the mandate is that they need to be sure that all medical instruments are accounted for prior to a patient being closed.
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Medical Instruments copy; 2012