Date of Graduation

Summer 8-11-2026

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Dr. Sara Horton-Deutsch

Second Advisor

Dr. Catherine Coleman

Third Advisor

Dr, David Ainsworth

Abstract

Abstract

Background: In a Northern California medical center with 11 operating rooms, two retained foreign object (RFO) events occurred following surgical procedures in 2025.

Problem: Surgical teams rely on manual counting processes to prevent retained foreign objects. Variability in counting practices among registered nurses and surgical technologists, combined with workflow interruptions and environmental distractions, can increase the risk of counting discrepancies and missed items. Standardizing the counting process may improve count accuracy and reduce the risk of RFOs.

Interventions: This quality improvement project implemented a standardized surgical counting process based on Association of periOperative Registered Nurses (AORN) guidelines within a surgical microsystem by July 2026 at the Northern California hospital.

Outcome Measure: Operating room efficiency was evaluated using surgical case duration (room-in to room-out time), collected from electronic medical record timestamps and operating room scheduling systems, to assess any unintended impact of the standardized counting process.

Results: Following implementation of the standardized counting process, no retained foreign object events were reported during the evaluation period. Operating room efficiency was maintained without clinically significant increases in surgical case duration.

Conclusion: Standardizing the surgical counting process using evidence-based AORN guidelines improved consistency among perioperative team members and was associated with the elimination of retained foreign object events during the project period. These findings suggest that a standardized counting process may enhance patient safety without adversely affecting operating room efficiency.

Keywords: surgery, surgical counting, standardized counts, retained foreign objects.

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