If an instrument count discrepancy occurs during surgery, what is the recommended course of action?

• A. Ignore and proceed to closure.
• B. Immediately stop the procedure and document the discrepancy.
• C. Re-count the instruments with the team and resolve discrepancies before proceeding.
• D. Continue without counts after disinfecting the area.

Answer: (C)

Counting instruments and other tracked items is a safety check used to prevent leaving a tool or sponge inside the patient. When a discrepancy is detected, the best course is to pause and re-count the instruments with the whole team, verify each item, and resolve any mismatches before continuing. This collaborative verification helps locate missing items, prevents a retained foreign body, and aligns with standard operating room protocols. Ignoring the discrepancy or proceeding after disinfecting would increase the risk to the patient, and stopping the procedure without a reconciliation doesn’t resolve the underlying issue. If the re-count cannot be reconciled, follow the facility’s escalation steps, which may include imaging and notifying the surgeon, before moving forward.