Re: Multi-Fail
There will usually be a nurse that's tasked with keeping track of instruments used. Definitely worth the expense.
A friend was that nurse, especially for the long (fourteen hour or more) orthopedic operations, that sometimes entailed a shift change among the support staff of nurses and techs. She scrubbed in as the second shift on one of these marathons. The first shift had made a proper mess of the sponge count. These little items are very easy to miss, once they are blood soaked and deep in the patient. They are brought to the ER in bags of ten, and the count is frequently updated, as more are used. The used ones are supposed to be counted as removed, and noted in groups of ten as well. SOMEHOW the first shift person had screwed up the count.
My friend could not make the count of sponges in and sponges out come out equal, but could not find the error, or where it had occurred (in the requisitioning of new packs? In the counts of used ones?) After the surgery, the head surgeon and she re-counted all the used sponges, ripping open the many used sponge bags to see if the miscount was there, a disagreeable and difficult task, as they stuck together and were hard to separate. They both signed off when they thought they had the right count, best efforts and all.
Long story short, at least one sponge was missed, the patient died, and as usual in US malpractice lawsuits, everyone who was anywhere near gets named in the suit, out to the guy mopping the corridor. That's when I found out that getting a metal instrument, a clamp, a needle, is bad but not always fatal, the body walls it off and continues on. A sponge is a focus for infection and much more likely to kill you before it can be found.
I don't think she was held liable, but it haunts her still, into retirement.