BHA-FPX4010 ASSESSMENT 4 INSTRUCTIONS: DEVELOP A RESEARCH PLAN
Introduction
Retained Surgical Items (RSI)—the unintentional leaving of instruments, sponges, or other materials within a patient’s body post-procedure—represents one of the most serious and preventable patient safety incidents in modern healthcare. These events, which occur in thousands of surgical procedures annually across the United States, lead to severe patient harm, prolonged hospitalization, re-operations, significant emotional distress, and enormous financial liability for hospitals. The complexity of the operating room (OR) environment, BHA-FPX4010 Assessment 4 marked by high stress, fast-paced workflows, and reliance on teamwork, often contributes to human errors despite existing safety protocols like counting procedures and checklists.
Addressing this critical patient safety concern requires a deep, systematic investigation into the underlying human, environmental, and systemic factors at play. This paper outlines a comprehensive qualitative research plan designed to explore these contributors, detailing the research problem, purpose, specific qualitative research question, and the proposed methodology for data collection, all while establishing clear measures for reliability and validity, fulfilling the requirements of this BHA-FPX4010 Assessment 4.
Part 1: Problem Statement
The continued, yet preventable, incidence of Retained Surgical Items (RSI) constitutes a critical failure point in patient care quality and safety throughout the U.S. health system. Data suggests that between 4,000 and 6,000 RSI incidents are reported annually, a number that is likely underestimated due to underreporting (Fenner, 2019).
These incidents are not minor; they often involve clips, needles, sponges, and other small items, necessitating costly and risky corrective surgeries and exposing patients to infection, chronic pain, and organ damage (Fencl, 2016). While technology, such as radio-frequency identification (RFID) tags, offers solutions, the core cause remains human error driven by poor communication, staff fatigue, distraction, high staff turnover, and inadequate adherence to safety protocols BHA-FPX4010 Assessment 4 (Birolini et al., 2016; Kim et al., 2015).
The current emphasis on simple count verification protocols, while necessary, is insufficient, as errors often occur when procedures change unexpectedly or during times of high-intensity communication breakdown, highlighting a gap between mandated policy and actual practice. Consequently, the research problem centers on understanding why these critical human errors persist and lead to RSI, despite the widespread implementation of surgical safety standards designed to prevent them. This qualitative exploration aims to move beyond simple frequency data to uncover the mechanism of failure.
Part 2: Purpose Statement
The overarching purpose of this research is to identify the non-technical and cultural factors within U.S. operating rooms that interfere with the successful implementation and adherence to surgical item safety protocols, ultimately aiming to diminish the prevalence of Retained Surgical Items (RSI). Specifically, this study proposes to observe surgical teams in high-volume settings to uncover tacit knowledge, BHA-FPX4010 Assessment 4 communication breakdowns, and structural limitations that contribute to human error.
The findings will be used to develop evidence-based recommendations for refining surgical safety checklists, enhancing interdisciplinary team communication training, and improving the organizational culture of safety within surgical units. By focusing on the “why” behind policy non-adherence, the research supports the broader goal of improving patient care outcomes through a systematic and actionable approach. The successful completion of this investigation will directly address the central challenge identified in this phase of the BHA-FPX4010 Assessment 4.
Part 3: Qualitative Research Question
Given the complexity and sensitivity of the operating room environment, a purely quantitative analysis of incident reports often fails to capture the rich, contextual factors that lead to error. Therefore, a qualitative research approach, specifically using an ethnographic methodology, is proposed. Ethnography allows researchers to immerse themselves in the setting to observe social dynamics, workflow processes, and the lived experiences of surgical staff (Chawla & Jones, 2017). This methodology is uniquely suited to answering the following research question:
What contextual factors, including communication patterns, cultural norms, workflow dynamics, and perceived barriers to protocol adherence, influence the surgical team’s effectiveness in preventing Retained Surgical Items (RSI) in high-volume operating rooms?
This question is designed to elicit deep insights into the root causes of error, such as the impact of power hierarchies on nurse-surgeon communication, the effect of interruptions on item counting, and the informal methods staff use to cope with time pressure. The results will provide the necessary depth to inform targeted, behavioral, and cultural interventions, which are often more effective in complex clinical settings than simple policy modifications BHA-FPX4010 Assessment 4 (Choo et al., 2015).
Part 4: Data Collection, Reliability, and Validity
Data Collection Method: Non-Participant Observation
The primary data collection method selected is non-participant observation within multiple surgical operating rooms. In this method, the researcher is present in the OR but does not actively engage in the surgical procedure or team conversation, minimizing the disruption of natural workflow and behavior. This approach, rooted in ethnographic principles, allows for the meticulous
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documentation of real-time interactions, task sequencing, physical layout utilization, and adherence (or non-adherence) to safety protocols (Smit & Onwuegbuzie, 2018).
The researcher will use a detailed observation protocol, including a structured checklist for key safety steps (e.g., initial count, count during closure, final count) and an open-ended field journal for recording contextual factors, non-verbal cues, environmental disruptions, and spontaneous staff commentary. Observation sessions will span across different shifts, case types, and team compositions to ensure a comprehensive view of OR dynamics.
Ensuring Reliability
In a qualitative study relying on observation, reliability—the consistency of findings—is established through rigorous procedural application and inter-rater agreement. To ensure reliability for this BHA-FPX4010 Assessment 4 task, the following strategies will be employed:
- Multiple Observers (Inter-Rater Reliability): At least two trained researchers will independently observe and document the same surgical procedures for a subset of cases. Their field notes and checklist entries will be compared for consistency. Any significant discrepancies will be discussed and reconciled until a high level of agreement (e.g., Kappa coefficient above 0.80 for structured checklist items) is achieved BHA-FPX4010 Assessment 4 (Hasnida & Ghazali, 2016).
- Detailed Protocol and Training: All observers will undergo standardized, extensive training on the structured observation protocol, ensuring they use identical definitions for workflow steps, communication categories, and error classification.
- Audit Trail: Meticulous documentation, including timestamps, situational context, and a clear distinction between raw observations and interpretive notes, will be maintained. This audit trail allows an external party to trace the research process from data collection to final findings, confirming procedural consistency.
Ensuring Validity
Validity in this qualitative context refers to the truthfulness and credibility of the findings—ensuring that the observations truly measure the intended social and cultural phenomena related to RSI prevention. Key strategies for enhancing validity include:
- Triangulation: Data collected via non-participant observation will be cross-referenced with additional sources, such as unstructured interviews with surgical staff (nurses, surgeons, technologists) and analysis of existing safety committee meeting minutes. Converging data from these multiple sources will strengthen the credibility of the emergent themes.
- Member Checking: Preliminary findings and interpretations will be shared with a subset of the surgical teams observed. Staff feedback on whether the researchers’ interpretations accurately reflect their lived experience in the OR is crucial. This step ensures face validity and strengthens the overall credibility of the study.
- Thick Description: The field notes and final analysis will include rich, descriptive details BHA-FPX4010 Assessment 4 (thick description) of the physical environment, social interactions, and specific events observed. This allows readers to judge the transferability of the findings to their own clinical contexts and demonstrates that the conclusions are well-supported by the evidence. By carefully following these protocols, the study aims for robust, trustworthy, and actionable insights into the prevention of Retained Surgical Items.
Conclusion
The development of a robust research plan is the foundational step toward mitigating the persistent, critical threat of Retained Surgical Items in healthcare. By establishing a clear problem, a focused purpose, and a deep, qualitative research question, this plan sets the stage for a methodologically sound study. The ethnographic approach, leveraging non-participant observation, is uniquely equipped to penetrate the complex social and behavioral dynamics of the operating room that underpin human error.
Furthermore, the systematic measures proposed for establishing reliability through inter-rater consistency and validity through triangulation and member checking ensure the resulting data will be both credible and highly actionable. Ultimately, this research, as outlined in this BHA-FPX4010 Assessment 4 framework, seeks to transition from identifying a problem to delivering the contextual insights necessary to make surgical environments demonstrably safer for every patient.
References
Birolini, D. V., Rasslan, S., & Utiyama, E. M. (2016). Unintentionally retained foreign bodies after surgical procedures: Analysis of 4547 cases. SciELO Analytics, BHA-FPX4010 Assessment 4 43(1), 12–17.
Chawla, D., & Jones, R. M. (2017). Ethnography/ethnographic methods. The International Encyclopedia of Communication Research Methods, 1–18.
Choo, E. K., Garro, A. C., Ranney, M. L., & Meisel, Z. F. (2015). Qualitative research in emergency care part I: Research principles and common applications. Academic Emergency Medicine Journal, 22(9), 1096–1102.
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.
Hasnida, N., & Ghazali, M. (2016). A reliability and validity of an instrument to evaluate the school-based assessment system. International Journal of Evaluation and Research in Education, 5(2), BHA-FPX4010 Assessment 4 148–157.
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).
Smit, B., & Onwuegbuzie, A. J. (2018). Observation in mixed methods research. Journal of Mixed Methods Research, 12(1), 17–45.
Woodman, N. (2016). World Health Organization surgical safety checklist. WFSA.
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