BHA-FPX4010 ASSESSMENT 1 INSTRUCTIONS: RESEARCH PROBLEM AND PURPOSE STATEMENTS
Introduction
The pursuit of optimal patient safety is the bedrock of contemporary healthcare delivery, yet preventable harm persists across clinical settings. Among the most concerning classifications of preventable harm are Hospital-Acquired Conditions (HACs). This paper focuses on a particularly critical type of HAC: the unintended retention of foreign objects (URFOs), commonly referred to as retained surgical items (RSIs). Despite sophisticated surgical techniques and standardized operating room protocols, the inadvertent leaving of surgical instruments or materials inside a patient’s body post-procedure remains a devastating reality.
This phenomenon causes physical and emotional trauma to patients, generates significant costs for healthcare institutions, and erodes public trust in the medical system. This paper will establish the background of this persistent problem through evidence-based literature, formulate a rigorous research problem statement that highlights the inadequacy of current preventative measures, and finally, propose a concrete purpose statement focused on implementing effective safety measures. The careful construction of these foundational elements is essential for guiding the subsequent research methodology and ensuring the success of the BHA-FPX4010 Assessment 1.
Background and Evidence
The scale of the problem is substantial. Pyrek (2017) noted that with an estimated twenty-eight million surgeries performed annually in the United States, between four to six thousand cases of retained surgical equipment are reported each year. This is a concerning statistic given the modern emphasis on patient safety culture and the implementation of universal precautions.
The Joint Commission (TJC) categorizes these events—which include sponges, towels, needles, and fragments of instruments—as sentinel events, signaling an incident that must be thoroughly reviewed for system-level failures (Fenner, 2019). These errors, which can lead to severe consequences such as infection, internal injury, reoperation, and even death, are entirely preventable.
The persistence of RSIs challenges the efficacy of existing safety mechanisms. In response to such critical lapses, TJC introduced the Universal Protocol in 2004, which mandates standardized procedures like time-outs and manual surgical counts (Kim et al., 2015). However, as the continuous reporting of RSI incidents demonstrates, strict adherence to counting protocols alone is insufficient to eliminate the risk. Human factors, including fatigue, distraction, high case volume, and inadequate communication within the surgical team, often compromise the counting process (Fencl, 2016).
Furthermore, as the incident reported by Liber (2018), where surgical sponges were retained for six years, illustrates, the harm is often long-term and devastating, leading to profound physical pain and emotional distress for the patient. Research continues to seek evidence-based interventions that go beyond traditional counting and leverage technology and team training to create robust safety nets. Addressing these gaps forms the core focus of the BHA-FPX4010 Assessment 1.
The comprehensive analysis by Birolini, Rasslan, and Utiyama (2016), which analyzed 4,547 cases of unintentionally retained foreign bodies, underscores the systemic nature of the issue rather than attributing it to isolated human error. The authors confirmed that while sponges and soft goods are the most common culprits, instruments and fragments also account for a significant portion of incidents. These events not only cause direct patient harm but also inflict massive financial burdens on hospitals, which often incur costs related to reoperation, extended hospitalization, legal fees, and regulatory penalties.
However, every incident of RSI should be viewed not merely as a failure, but as a crucial learning opportunity for hospitals to enhance safety practices and reinforce continuous quality improvement (Birolini et al., 2016). Therefore, a systematic approach is needed to analyze existing protocols and integrate proven, multidisciplinary measures into standard practice.
Research Problem Statement
Despite the establishment of mandatory Universal Protocol guidelines and manual surgical item counts, the continued prevalence of retained surgical items (RSIs) remains a critical, recurring patient safety crisis across U.S. hospitals. Annually, thousands of surgical procedures report incidents of retained equipment, directly compromising patient outcomes, increasing morbidity and mortality, and resulting in significant financial and reputational losses for healthcare institutions. The fundamental problem lies in the reliance on procedural safeguards that are susceptible to human error, particularly under the high-pressure, complex, and fast-paced demands of the operating room environment.
Current protocols are failing to provide a foolproof safety barrier against RSIs, indicating an urgent need for the systematic implementation and rigorous evaluation of advanced, evidence-based interventions that integrate technological and team-based strategies. This persistent gap between required safety standards and actual patient outcomes necessitates immediate
research and corrective action to protect patients and uphold the quality mandate of modern surgical care. The urgency of this topic makes it highly relevant for the BHA-FPX4010 Assessment 1 requirements.
Purpose Statement
The purpose of this study is to implement and rigorously evaluate the efficacy of a comprehensive, evidence-based safety bundle—modeled after the National Patient Safety Agency’s (NPSA) “Five Steps to Safer Surgery” framework—in reducing the incidence of Retained Surgical Items (RSIs) within a large tertiary care surgical department over a twelve-month period. This research seeks to move beyond traditional manual counting by integrating a multi-modal strategy that includes the adoption of technology (such as radiofrequency identification [RFID] tagging for surgical sponges), mandatory pre- and post-operative team briefings (huddles) focused exclusively on item reconciliation, and standardized, non-punitive event reporting mechanisms.
The study will measure the change in the rate of URFOs and assess staff adherence to the new safety bundle to identify the most effective components of the intervention. By confirming the effectiveness of a proactive, holistic approach to surgical safety, this study aims to provide a replicable model for hospitals nationwide, thereby mitigating patient harm and elevating the standard of surgical care. Successfully executing this purpose aligns directly with the objectives of the BHA-FPX4010 Assessment 1.
Significance and Methodology Considerations
To address the formulated problem and achieve the stated purpose, the research would likely employ a quasi-experimental, pre- and post-intervention design. This approach would involve collecting baseline data on RSI incidents before the safety bundle implementation (the pre-intervention phase) and then comparing it to data collected during and after the twelve-month implementation period (the post-intervention phase). The chosen setting—a large surgical department—ensures a sufficient volume of cases to detect statistically significant changes in RSI rates.
The implementation of the NPSA Five Steps, or a similar comprehensive program, is critical because it introduces redundancy and verification (Fencl, 2016), moving safety from a single-point failure system (manual counting) to a resilient, multi-layered system (technology, teamwork, standardization). Furthermore, the research must consider qualitative data, such as surgical team interviews and perception surveys, to evaluate barriers to adoption and facilitators of compliance, ensuring the long-term sustainability of the safety improvements.
The significance of this study extends beyond the immediate reduction of errors. By providing conclusive data on a successful intervention, the research contributes directly to the evidence base for national patient safety policies and protocols. It offers a tangible solution to a pervasive problem, translating academic findings into practical, life-saving procedures. The findings will provide essential guidance for healthcare administrators and clinical leaders seeking to invest in safety technologies and training programs that yield the highest return in patient well-being.
Ultimately, demonstrating a measurable, sustained reduction in RSI incidents is a critical step in restoring patient confidence and fulfilling the ethical imperative of ‘do no harm.’ The rigor and scope of this necessary investigation validate its inclusion in the BHA-FPX4010 Assessment 1.
Conclusion
The retention of surgical items post-procedure represents a profound and unacceptable failure in the healthcare system’s commitment to patient safety. The literature clearly establishes the high incidence, severe consequences, and the inadequacy of current error-prone manual protocols. The research problem is thus the persistent failure of existing single-layer safeguards to prevent these catastrophic sentinel events. The corresponding purpose statement focuses on implementing and evaluating a comprehensive, evidence-based, multi-modal safety bundle to create a resilient system of checks and balances.
By moving toward technological augmentation, enhanced team communication, and robust standardization, healthcare organizations can effectively reduce RSIs, mitigate harm, and uphold the highest standards of surgical care. The successful execution of this study provides a crucial roadmap for systemic improvement, directly supporting the foundational knowledge required for the BHA-FPX4010 Assessment 1.
References
Birolini, D. V., Rasslan, S., & Utiyama, E. M. (2016). Unintentionally retained foreign bodies after surgical procedures. Analysis of 4547 cases. SciELO Analytics, 43(1), 12–17.
Fencl, J. L. (2016). Guideline Implementation: Prevention of Retained Surgical Items. AORN Journal, 104(1), 37–48.
Fenner, K. (2019). The Joint Commission’s Hospital National Patient Safety Goals for 2018. Compass Clinical Consulting.
Kim, F., da Silva, R., Gustafson, D., Nogueira, L., Harlin, T., & Paul, D. L. (2015). Current issues in patient safety in surgery. BMC, 9, 26.
Liber, M. (2018). Surgical sponges left inside woman for six years. CNN Health.
Pyrek, K. (2017). Preventing Retained Surgical Items is a Team Effort. Infection Control Today.
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