SELF/Perioperative Nursing/Surgical Counting/Psychomotor Skills Practice Instructions
Surgical Counting – Perioperative Nursing (ECSACONM)
[edit | edit source]Overview
[edit | edit source]This page provides a psychomotor skills practice guide for surgical counting, developed for perioperative nursing training under ECSACONM (East, Central and Southern Africa College of Nursing). It is intended as a self-directed developer worksheet, outlining the sequential steps, associated learning objectives ("good skills"), common errors, and practical guidance for performing accurate surgical counts throughout a procedure.
To promote efficient use of resources, items such as instruments, gowns, drapes, gloves, and other consumables may be used in an unsterile state for practice purposes. During all skills practice activities, learners should handle and use these items as though they are sterile and intended for patient care, demonstrating correct aseptic technique and adherence to sterile principles throughout the procedure.
NB: The below skills should be practiced with an assistant.
Purpose
[edit | edit source]To guide nursing students and practitioners through a systematic, step-by-step process for performing surgical counts, ensuring continuous accountability for all countable items, prevention of retained surgical items, and clear communication and documentation throughout the procedure.
Psychomotor Skills Practice Instructions
[edit | edit source]| Step | Instructions | Good Skills (Learning Objectives) | Common Errors | Guidance | |
|---|---|---|---|---|---|
| 1 | Gather supplies | Say to the instructor that you would gather all necessary supplies based on the case and surgeon preference. | |||
| 2 | Organize items visibly on sterile field | Arrange instruments, sharps, and sponges in a standardized and easily visible manner. Similar items should be grouped together and positioned to allow rapid identification and recounting. | Learner maintains an organized sterile field that supports efficient counting and identification of missing items. Assessed on organization and visibility of items. | Cluttered setup; mixing different item types; stacking items so they cannot be seen; poor sterile field management. | Create designated locations for sponges, sharps, and instruments. Good organization prevents later discrepancies. |
| 3 | Perform initial (baseline) count | Before the procedure begins, systematically count all sponges, sharps, needles, instruments, and other countable items with the circulating nurse according to local protocol. Handle items one at a time, separate similar items into organized groups, and verbally confirm quantities. | Learner accurately identifies and counts all countable items, follows the prescribed counting sequence, and actively participates in verbal verification. Assessed on accuracy, organization, and communication. | Counting too quickly; skipping item categories; failing to visually verify items; poor communication with the second counter. | Always use the same counting sequence and physically separate items as they are counted. Consistency reduces counting errors. |
| 4 | Document initial count clearly | Mention to the examiner that you would immediately record the baseline count on the count sheet, whiteboard, electronic record, or local tracking system according to institutional policy. You would confirm recorded values match the verbal count. Everything gets documented IMMEDIATELY after counting. Do not rely on memory later in the procedure. | |||
| 5 | Monitor use of items during surgery | Continuously observe the addition, removal, use, and disposal of countable items throughout the procedure. Maintain awareness of item movement between the sterile field, wound, and waste containers. | Learner actively tracks countable items and maintains situational awareness throughout the procedure. Assessed on vigilance and count maintenance. | Losing track of items; multitasking to the point that count awareness is lost; assuming another team member is tracking counts. | Develop the habit of mentally tracking items as they move. Anticipate when recounts may be needed. |
| 6 | Add new items to count | Whenever additional sponges, sharps, needles, or instruments are opened, stop and perform a verbal count with the second counter before the items enter use. Update documentation immediately. | Learner incorporates newly introduced items accurately into the ongoing surgical count using verbal communication and visual verification, and updates documentation promptly. Assessed on accuracy of count integration, timeliness of documentation and communication. | Using newly added items before counting them; failing to update count records; poor communication between counters. | Treat every newly opened item as if it were part of the initial count process. |
| 7 | Perform intraoperative counts during designated phases of the procedure | Conduct additional counts at designated milestones, staff changes, cavity closure, or whenever count integrity is uncertain. Follow the same systematic counting method used for the baseline count. | Learner performs methodical recounts and maintains count accuracy during procedural transitions. Assessed on consistency and adherence to protocol. | Rushing counts; skipping categories; performing counts in a different order than baseline. | Use exactly the same counting sequence every time to reduce omissions. |
| 8 | Perform final counts before wound closure | Before final wound closure, perform a complete count of all countable items with the second counter. Visually inspect the sterile field, instrument table, waste receptacles, and designated counting areas. | Learner completes a thorough final count and verifies all items are accounted for before closure. Assessed on completeness, attention to detail, and communication. | Incomplete search; accepting uncertain counts; rushing due to time pressure; failure to inspect all count locations. | Slow down during final counts. This is one of the highest-risk moments for retained surgical items. |
| 9 | Investigate any discrepancies immediately | If a count discrepancy occurs, stop progression of the count process and initiate a systematic search according to local protocol. Recount items, inspect the sterile field, wound, floor, waste containers, and surrounding environment. Escalate appropriately. | Learner responds immediately to discrepancies and follows a structured investigation process. Assessed on escalation, problem-solving, and protocol adherence. | Ignoring discrepancies; delaying investigation; assuming counts are correct without verification; incomplete search. | Never assume a missing item will "turn up later." Treat every discrepancy as clinically significant until resolved. |
| 10 | Document final counts and any actions | Say to the examiner, you would make final counts, record results, initiate discrepancy investigations if any, take corrective actions, and report final count status according to institutional policy. You must ensure communication with the surgical team is complete. Documentation and clear communication should allow another clinician to understand exactly what was counted, investigated, and resolved. |
References
[edit | edit source]
| Authors | Ian-laurel |
|---|---|
| License | CC-BY-SA-4.0 |
| Organizations | SELF, ECSACONM |
| Cite as | "SELF/Perioperative Nursing/Surgical Counting/Psychomotor Skills Practice Instructions". Appropedia. 2026. Retrieved July 14, 2026. |