I’ve been thinking about bird feeders, golf clubs, and automated drug-dispensing cabinets.

Snow falling in record quantities has not deterred God’s smaller creatures from visiting the bird feeder outside my window. Nor has it impacted their access behaviors.

Presently, black-capped chickadees are having a free for all—two, then five, now ten at a time. Each stays a few seconds, grabs a seed or two, and moves on. Cooperative little tweets. Gladly each respects the queue.

Now and again a fat northern flicker, around ten times the body mass of a chickadee, lands and rules the dispenser while flicking massive quantities of seeds onto the ground beneath. That is unless a mountain blue jay is in the neighborhood. Toronto was onto something when they named their baseball team after these blue terrorists that send all our other feathered friends flying.

Then there are the resident squirrels. Pecking order exceeds the genera of beak-bearing critters. All creatures, great and small, flee when they show up—except for me. Squirrels make my adrenaline spike when they fail to differentiate between birdseed and peanuts. They have absolutely no respect for the concept of a bird feeder.

Admittedly, I take to squirrels chasing each other around the yard and up our trees. But when it comes to stealing birdseed, they are squirrels—rude, stubborn, intrusive rodents.

We have trimmed the branches of nearby trees and taken out bamboo stalks, but all we’ve done is raise the bar. Though they’re not the flying variety, these little beasts are world-class jumpers.

I don’t even want to waste a sentence on the rat that ransacks our feeder by night. Let’s just say he’s well-named.

I’ve tried attacking them with a golf club, but they are gone before I can get the window open. I think about wrapping the feeder with wire attached to a battery and fantasize switching on the juice while the rodents are snacking and watching how high the really can jump. My friend in Minnesota swears by the pellet gun. He’s a surgeon. I said, ”Yeah, but our feeder is too close to a window.” He said, “That’s OK. It’s worth it. There are few things in life as satisfying as seeing a squirrel on its back with a grand mal seizure.”

Most frustrating is that we have a hard time keeping our birdseed- dispensing device replenished for the chickadees.

Last week I was engaged with a hospital system preparing for bar-code-enabled medication administration. In the process, like so many hospitals, they have realized the value in revisiting their entire drug distribution and dispensing system, which includes using their automated dispensing cabinets (ADCs) more safely and efficiently.

Their issues made me think of mine with our bird feeder.

I’m sure there’s a manual out there for how to manage bird feeders in a way that controls access and keeps the rats, squirrels, and maybe even the jays away. I just haven’t taken the time to fetch and read it.

When it comes to ADCs, for starters, it is not uncommon for needed meds to unnecessarily go out of stock or for the wrong kind of users (if you know what I mean) to gain access to the drugs. Good news: There is a manual out there with almost everything you need to know about using ADCs safely and efficiently. It’s called
ISMP Medication Safety Self-Assessment for Automated Dispensing Cabinets.

The problem is that not enough hospitals use it, and many that do don’t use it often enough. ISMP recommends going through the assessment on a quarterly basis. Sounds about right to me. Perhaps it’s time for your organization to pull this trustworthy tool off the Internet shelf, dust it off, and use it. It’s an easy-to-follow checklist for an interdisciplinary team that covers all the bases.

I cherry-picked a few items from the assessment, which asks you to check A “no activity,” B “discussed but not implemented,” C “partially implemented in some areas,” D “fully implemented in some areas,” or E “fully implemented throughout the organization” for each item. For example:

• There is an interdisciplinary team that monitors, at least on a quarterly basis, the ongoing safe use of ADCs, (e.g., work-flow issues, location of cabinets, quantity, and service). A B D C E

• All staff with access to automated dispensing cabinets (ADCs) receive orientation and ongoing competency training on the safe and proper use of ADCs. A B D C E

• Sufficient numbers of automated dispensing cabinets (ADCs) are available throughout the organization to meet the needs of the medication- distribution system. A B D C E

• Pharmacy personnel are assigned to monitor par levels of ADCs for low critical values and to replenish stock when necessary. A B D C E

• Monitor for lines in front of the ADC to access medications. A B D C E

ADCs are sort of like golf. A good game has more to do with your swing than the brand of your clubs. It’s pretty hard to play golf without clubs. But my experience suggests that while the majority of hospitals have pretty good ADCs, most need to work on their swing.

I will let you draw your own parallels between the menagerie outside my window and the ADC users in your hospital.

I have to go—the squirrel’s back.

Mark Neuenschwander a.k.a. Noosh