A woman’s worsening illness and severe pain following a hysterectomy was caused by a surgical swab left inside her, but it remains unclear how it happened. The Deputy Health and Disability Commissioner has called it a clear demonstration of a systems failure in that counting surgical swabs “clearly failed” in this instance, and that the healthcare provider had breached the Code of Health and Disability Services Consumers’ Rights. Dr Vanessa Caldwell said in findings released today that the incident highlighted the need for “hyper-vigilance” during surgery.
The incident at Manukau SuperClinic hospital in December 2021 has prompted a list of recommendations including that Health NZ Counties Manukau audit 20 patients’ records from the past three months, to identify compliance with the gynaecology service’s (swab) count policy, and conduct a refresher training session for existing staff on this policy..