I’ve Been Thinking about shower curtains, seat belts, and the increasing expectations on America’s hospitals to utilize bar-code point-of-care (BPOC) systems.

I’ve been thinking about shower curtains, seat belts, and the increasing expectations on America’s hospitals to utilize bar-code point-of-care (BPOC) systems.

While shaving this morning in the Harrisburg Hilton (CNN mumbling in the background), I recalled something I read thirty-five years ago. Someone asked Barron Hilton if he had any advice for America’s businessmen. “Yes,” he answered, “put the shower curtain inside the tub.” Those nagging expectations, ubiquitous on hotels’ tiled-tub enclosures in the 50s and 60s, disappeared before Hilton’s granddaughter, Paris, was born. Yet, to this day I’m compliant, even though I’ve never heard of anyone being busted for getting water on a bathroom floor.

Speaking of Paris Hilton, CNN segued to their entertainment segment as I was leaving my room—something about Britney Spears and Paris topping the celebrity-prone DUI list. On the elevator ride to the parking garage, I recalled the pictures repeatedly flashed on television early last year of Britney driving with her baby boy on her lap. Her excuse of needing to flee the paparazzi didn’t satisfy any of us the least bit.

Expectations related to seat restraints are pretty high these days. In my state (Washington), for example, fail to “click it,” and you are risking a $101 ticket (not to mention a 50 percent greater chance of being killed if you are in an accident). In Brittney’s state (California), you risk a $371 fine for each child in the car not properly buckled up (to say nothing of the 71 percent greater chance your child has of being killed if you are in an accident). Had Britney been in a wreck and her child died, she would have been looking at more than a ticket.

For the past decade, I have preached that bedside scanning is to patient safety what seatbelts are to passenger safety—not the only thing but certainly a salient thing.

When I picked up my car at the Avis desk last night, a sign behind the counter advised renters in line:

“Buckle up. Adjust your mirror. Drive safely.”

BPOC technology does not replace the caregiver, any more than mirrors, seatbelts, and GPS systems replace drivers. Look every direction. Proceed carefully. But because accidents happen, we should wear seatbelts and scan medications. Both prevent harm and save lives. A Veterans Administration study showed the BPOC reduced medication errors by 86.2 percent!

In my last column, I mentioned the nurse in Madison, Wisconsin, who this past summer mistakenly administered the wrong drug to a sixteen-year old girl in labor—causing the patient’s death. In November the nurse was charged with a felony. The state inspection report stated that she neglected to use the hospital’s point-of-care scanning system—designed to catch such errors before they reach patients.

We grieve for the family of the girl and for the nurse, who like all her colleagues, longs to do no harm. Not knowing all the circumstances, I am in absolutely no position to judge this caregiver. She remains in my thoughts and prayers.

However, I honestly believe that St. Mary’s mistake is the handwriting on the wall for America’s hospitals. If a caregiver is charged with a felony because she neglected (for whatever reason) to use the bar-code system the hospital had in place, what might this mean for hospitals that have neglected (for whatever reason) to put bar-code systems in place?

In 1968, the federal government required manufacturers to install seatbelts in automobiles. It took nearly three decades before the first state mandated their use. It took another decade for all states to adopt similar legislation. Just this past year, the State of Washington achieved a 95 percent compliance rate. Thousands of lives have been saved.

Don’t think for a minute that it will take as long with bar-code scanning. Whether hospitals are mandated or not, momentum is building, and expectations are increasing. I’m wagering that before this decade ends, it will be as unconscionable not to scan patient and medication bar codes at the bedside as it is not to fasten our seatbelts or buckle our children into infant seats before we put our cars in gear.

Meanwhile, I’m concerned about some hospital leaders out there who seem to have been expending less thought and effort to implement BPOC for their nurses and patients than hoteliers have invested to persuade guests to put shower curtains inside bathtubs—the same folks whose blood boiled with ours when they saw the Britney and baby pictures on the tabloids in grocery lines.

What do you think?

Mark Neuenschwander
mark@hospitalrx.com
© 2007 The Neuenschwander Company