Retained Foreign Objects (RFO) increase patient morbidity and mortality, as well as hospital cost. Despite safeguards such as counting protocols, RFO still remain a risk. An estimated 1,500 cases of RFO occur annually in the US. To promote patient safety, Memorial Sloan Kettering has implemented new guidelines to prevent the occurrence of a retained foreign body. In 2009, 19,233 procedures were performed in MSKCCs Operating Rooms. Like other ORs, MSKCC is vulnerable to RFO. We have experienced our share of RFO and near-miss events. To ensure patient safety, the following interventions have been implemented: Revision of count policy, including count times, and items counted; revision of Count Sheet Elements added and deleted; add area for documentation of closing instruments; update process for incorrect count; revision of x-ray requirements for sponges and needles; reinforcement of CPD count sheet use; decrease the number of instruments on trays; adoption of Red Zone; no staff change during counts; Handoff Key points are reviewed; staff change not permitted during critical moments; role determination; roles refined for two circulators; surgeon participation; perform a purposeful search of the wound; communicate sponges placed in wound; clear count; implemented count and detection technology; debriefing; and implemented process QA monitoring. The combined strategy of increased communication, mechanical intervention, and monitoring has helped in accomplishing and maintaining our goal. We have been incident free for 382 days.