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Surgery is a method of treating diseases that can eliminate diseases or inhibit abnormalities. However, unexpectedly in the course of surgery is likely that some problems could occur after operation, such as a surgical instrument is inadvertently left behind in a patient's body. The objective of this study was to develop guidelines to prevent retaining any surgical item in a patient's body by applying Six Sigma. The samples were purposively selected and were divided into three groups: 40 surgical patients on abdomen, thoracic cavity, and pelvis, 42 professional nurses, and 35 surgical nursing records. Research instruments consisted of checklist to prevent retaining surgical items in a patient's body, a process analysis diagram and a fishbone diagram. The research methodology included five steps: determining scope of problems, measuring problem conditions, analyzing causes of problems, improving and controlling. The results of the study were found that there were nine steps to prevent retaining surgical items. The problem was the percentage of conformity less than 80 in almost every step. The causes of the problem were from four factors; individuals, surgical items, methods, and working conditions. The guidelines were determined into the following five preventive measures: stimulating responsibility consciousness, recording the number of the instruments immediately and clearly, improving the used swab placement and counting the number of the used swabs, controlling and supervising if the number of the swabs packed in the wound after operation was recorded and reducing loud noise when counting. The results after the guidelines implemented found that the percentage of preventing retaining surgical items increased from 83.2 to 97.5 and the quality level rose from 2.2 to 3.1 sigma.
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