Articles and Studies

I’ve been thinking about hospital game plans for improving the accuracy of patient identification.

The Joint Commission’s (TJC) number-one National Patient Safety Goal (NPSG) for 10 years running expects hospitals to “improve the accuracy of patient identification.” “The intent for this goal is two-fold: first, to reliably identify the individual as the person for whom the service or treatment is intended; second, to match the service or treatment to that individual.”

Currently, the goal does not require utilizing positive ID technology. However, when matching blood products with patients, an accompanying note in the most recent “standards of performance” reads: “If two individuals are not available, an automated identification technology (for example, bar coding) may be used in place of one of the individuals.”

I’ve been thinking about birthing, bicycling, and bar coding.

This week, my youngest of five (whom I delivered at home twenty-five July’s ago) gave birth to her first, also at home. Relax. Both were low-risk with certified midwives present and hospital backup nearby. While holding tiny George—my sixth grandchild—for the first time, I pondered afresh: What’s a child worth?

In the opening credits of the Simpsons, baby Maggie is featured going through a supermarket checkout with the subtotal on the register reading $243.26. How the kid ends up on the conveyor belt is hard to tell, but when the checker swipes her over the bar-code reader, the total jumps to $486.52. Do the math, and Homer’s daughter is worth $243.26.

I’ve been thinking about the Dodgers, George Carlin, Nurse Jackie and drugs—oh yeah, and near misses.

It’s Monday about to turn Tuesday. Our return flight to Seattle has been weather-delayed after our weekend in So Cal. On Saturday, we nearly missed the Yankees/Dodgers game due to an equipment-delay. United’s mechanics came close to cancelling our southbound journey. Not sure why. It was only the navigational system.

In April, near Dodger Stadium at Bob Hope International, two planes were involved in what The Huffington Post called a “near miss.” A jetliner came within two plane lengths of colliding with a Cessna. Was the collision-avoidance interface to the plane’s navigational system on the blink? It’s all under investigation. Meanwhile, I’m thinking about George Carlin’s airline routine. “Here’s one they just made up. When two planes almost collide, they call it a near miss. It's a near hit! A collision is a near miss. Boom. Look, they nearly missed.”

I’ve been thinking about the need for traveling mercies on the patient-safety technology highway.

It’s Memorial Day weekend, and the Washington jackpot for Wednesday’s drawing is $260 million. Which reminds me of the guy who prayed all his life that he would win the lottery and didn’t. Frustrated, he asked, “Why?” God answered, “You never bought a ticket.”

Speaking of Memorial Day, this weekend marks the beginning of America’s road-trip season. Over the years, it seems I’ve heard as much about how many people are killed in vain on our nation’s highways over the holiday as I have about soldiers lost defending our country overseas.

I’ve been twittering and pondering how we could share The unSUMMIT for Bedside Barcoding with friends who can’t make it to Atlanta May 5-7. And I found a way. Three of my favorite birds on the wire will be sending tweets from The unSUMMIT that you won’t want to miss: Patient Safety and Quality Healthcare’s editor, SusanCarr; HCA’s director of patient safety, Barbara Olson, a.k.a. SafetyNurse; and the tech-savvy hospital pharmacist, JFahrni. Catch their ah-ha’s and oh-my’s via #unSUM10.

In the last thirty days, I’ve flow over 40K miles with stops in San Francisco, Philly, Sao Paulo and Melbourne. Being on the road made me think of, well, being on the road—again. Hope you’ll indulge a departure from my routine subject matter in this I've Been Thinking. Here goes.

I’ve been thinking about checklists.

My kids and their kids love Arnold Lobel’s Frog and Toad stories. So do I. My favorite is A List.

Still in bed, Toad decides to make a list so he can remember all the things he must do in the day before him. He scribbles, wake up, which he crosses out right away because he’s already done that. Then he scratches, get dressed, eat breakfast, go to Frog’s house, eat lunch, take walk with Frog, and so on. Eventually he writes eat supper and concludes with go to bed. After getting dressed and eating breakfast, he crosses them out and heads for Frog’s house. While showing off his list, a gust of wind sweeps it high into the air. “What will I do without my list?” he cries. The ever-fixing-things Frog suggests that if they hurry they can catch the list. But Toad protests, “I can’t. Running after my list was not on my list of things to do today.”

I’ve been thinking about the impact of mobile computing on fertility, frugality, mortality, and posterity.

Recently, I posted a picture of my sixth grandchild on Facebook. A buddy in California wrote something on my wall about knowing me when I was infertile. He’s right. It took nearly a decade of trying. Finally, we adopted a two-year old, whereupon, in rapid succession, three more followed by conventional means. Four was plenty. Then we confused ovulation dates. Enter number five.

Now, my kids appear to be on pace for doubling the grandchildren every five years. We’re talking about a herd of 64 when I’m 82, not factoring in twins or octuplets. BTW, I’m told that four of my six grand kids are oops babies.

I’ve been thinking about product ID, apples, priests, and rabbis.

Don’t you hate it when you snag an apple from the fruit bowl and bite into a sticker? I find it even more annoying if stickers are missing from apples when I get to the self-checkout lane. It’s easier and quicker to key in sticker numbers than to look up apples by alphabet and pictures on the touch screen. Keying numbers is also more accurate, especially when you can’t remember which look-alike you grabbed—Fuji, Gala, Pink Lady?

This week I learned that the FDA is on the verge of approving laser labeling for fruits and vegetables. Lasers burn harmless but readable calluses (e.g., Fuji, Gala, Pink Lady) into apple peels. This patented process that TIME called one of the best inventions of 2005, will make it harder for shoppers to confuse Granny Smith organics with those bathed in pesticides.

I’ve been thinking about automated dispensing machines, traffic cameras, Michelangelo, and Atlanta in May.

On a recent NPR program, experts discussed how installing cameras at intersections increases citations while decreasing violations. Initially, revenue from tickets exceeds the costs of the technology and personnel required to manage it. Within a few years, however, traffic cameras modify behavior so effectively that eventually there are barely enough violators to cover the cost of the electronic law-enforcement systems. Mission accomplished.

To make narcotics diversion more difficult, most hospitals have installed automated dispensing machines (ADMs). On Showtime’s third episode of the premiere season of Nurse Jackie, the ever-irascible RN of All Saints appeals to Dr. Cooper: “Vote ‘no’ on the Pyxis.” When asked why, she snips, “That machine is not only an insult to nurses, it is squeezing Eddie out of a job.” Turns out, Eddie is the pharmacist who helps Jackie divert narcotics to sustain a habit that makes Vicodin-popping House look like a rookie.

December 2009

I’ve been thinking about yesterday’s JC Penney, tomorrow’s airport security, and today’s pharmacy (i.e., deeply penetrating material ID technology).

The shoe department at my childhood JC Penney had a snazzy x-ray machine. After shoehorning my feet into a pair of Buster Browns, the salesman had me slip them into the opening near the bottom of an Art Deco shoe-fitting box. On top were three ports through which he, my mother, and I viewed a fluorescent image of the bones of my feet and the outline of the shoes. None of us wore lead aprons to protect our fertility from the gamma rays. Apparently it didn’t matter as I have five kids.