Joint Commission Issues Sentinel Alert for Surgical Instruments Left in Patients

The Joint Commission has issued a sentinel event alert for ambulatory surgery centers and hospitals regarding the prevention of leaving unintended surgical instruments in patients.

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The average total cost of care per incident is estimated to be from $166,000 to more than $200,000.

The Joint Commission recommends:

•    Development of a counting system to ensure all surgical instruments are accounted for
•    Implementation of an evidence-based, facility-wide protocol for prevention
•    Effective communication between all team members
•    Careful documentation
•    Safe selection and use of technology

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