TITLE: GUIDELINES FOR THE USE OF RADIOLOGY DIAGNOSTIC REQUEST (FOR INCORRECT SPONGE, NEEDLE AND SHARP COUNTS)

INSTRUCTIONS:

1. Affix patient identification label.
2. PERTINENT HISTORY - State "Incorrect sponge, needle or sharp count."
3. Write "CHARGE TO Labor & Delivery" (so the patient won’t be charged).
4. DIAGNOSIS - Operative procedure being done.
5. EXAMINATION - Area to be x-rayed.
6. SPECIFIC INFORMATION - Item looking for.
7. HOSPITAL/CLINIC LOCATION OF PATIENT - Put "Labor and Delivery" and the unit that the patient is from.
8. STRETCHER/WHEELCHAIR - N/A, leave blank.
9. DATE OF REQUEST - Date request is made for x-ray.
10. EXAM IS DESIRED - N/A, leave blank.
11. REQUESTED BY

1. NAME - The operating surgeon’s name and name of circulating nurse.
2. HOSPITAL NUMBER/PAGER NUMBER - N/A, leave blank.

12. This section and the back of the form is to be left blank for the Department of Radiology.

RESOURCE PERSON(S): Donna Norsworthy, HNM-Labor and Delivery

Back to Guidelines Table of Contents
Home