What steps should be taken if there is a discrepancy in instrument or sponge counts?

• A. Wipe items and continue
• B. Notify the surgeon
• C. Pause surgery, verify counts, search for missing items, notify the surgeon, and document
• D. Proceed with surgery before counts are resolved

Answer: (C)

Ensuring all instruments and sponges are accounted for is a patient safety priority. When a count discrepancy occurs, the team should pause the procedure, perform a verified re-count with a second person, and then conduct a careful search of the sterile field, the back table, and other potential item locations for the missing item. The surgeon must be notified so a decision can be made about next steps (such as imaging or adjusting the plan), and the event should be documented in the chart and count logs. Only when counts are reconciled and no item is missing should the operation resume.

Wiping items and continuing risks hiding a missing object. Merely notifying the surgeon doesn’t initiate the necessary search and verification. Proceeding before counts are resolved creates a real danger of a retained surgical item and potential harm to the patient.