Toolbox

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.

I’ve been thinking about Shaquille O'Neal, Spud Webb, Bill Russell, and me. After all, we have so much in common.

We all played basketball in college, had knee surgery as adults, don’t like the Lakers, Twitter, paying taxes, and probably will be hospitalized again before we die.

True, I’m nearly a foot and a half shorter than Shaq and a foot shorter than Russell, but I stand a half-foot taller than Spud. And, while I have yet to dunk a basketball, there was a time (before Shaq was born and while Russell was a Celtic) that I had the hops and hopes.

We all know Shaq’s got the tattoos. I’m pretty sure Spud and Russell don’t. Neither do I, although I am planning on getting some ink once 80 percent of America’s hospitals are using bar-code scanning at the point of care (BPOC). I’m thinking a small (very small) bar code on my arm. I’ll Twitter you before the ink is dry.

I’ve been thinking about Roy Rogers, meaningful use, and wet cement.

I made my first cognitive visit to Grauman's Chinese Theater on Hollywood Boulevard in the late 1950’s. Roy Roger’s hands, boots, and six-shooter, next to Triggers front feet, danced off the sidewalk and into my soul as I traced my fingers through the TV stars' impressions. A seed was planted. Someday. Somewhere. Somehow.

My heart raced the morning a cement mixer stopped in front of our house. A star was born that afternoon when I left my handprints in the freshly poured driveway. Thank God, I didn’t wait longer than I did. Cement dries quickly, you know. My impressions were not as deep as Roy’s. But, hey, they're still there at 3945 Carlin Ave, Lynwood CA.

I’ve been thinking about dry cleaners, prophets, Goofy, and sushi.

In the majority of US hospitals, pharmacy personnel walk about hunting and gathering medications to fill patient cassettes and fulfill automated-dispensing cabinet (ADC) replenishment orders. Nearly 400 hospitals have handed over cassette-fill to fully automated bar-code-literate robotics.

Between all-hands-on-deck and hands-free paradigms, around 800 hospitals have brought in semi-automated carousels to assist technicians with ADC replenishment and, in some cases, with patient-cassette fill, if not first-dose picks.

I’ve been thinking about babies, bar codes, and bathwater.

Twenty years ago, I made the obligatory pilgrimage with my five kids to Chuck E Cheese. Ugh. A few months ago, I made my second and final visit—this time with my grandson. Two noteworthy changes: Chuck E’s token-gobbling entertainment technology has been upgraded, and he’s installed a Kid-Check security system with the commitment: “Everyone that comes together, leaves together.” On the way in, whole families are now stamped with unique identifiers in invisible ink. On the way out, stamps are black-lighted to ensure all children belong to the adults with whom they are departing. This is not your father’s Chuck E Cheese.

I’ve been thinking about weekends and positive-product ID.

Consider a weekend in the life of a do-it-yourselfer. After my third trip in two days to Lowe’s Home Improvement, I discovered that one of the nuts did not match one of the bolts I had purchased to repair my gate. Had another backyard warrior put the nut back in the wrong bin on aisle five? Perhaps it was an unattended child rearranging inventory or an employee whose mind was elsewhere while stocking the bins. It doesn’t matter. I had to make a fourth trip. Nuts.

Speaking of fourth, the fourth lesson Robert Fulgum says we should have learned in kindergarten fits here: “Put things back where you found them.” My dad has preached and practiced this rule all 87 of his years. “A place for everything,” he insists, “and everything in its place.” I tell you, the man has CDO—that’s obsessive-compulsive disorder arranged in alphabetical order, as it should be. I’ve often thought, Pops would have been a good pharmacist.

I’ve been thinking about fiber, movies, and good old Spic and Span.

Admittedly, I’ve been thinking too long about it. Actually, I’m eleven years late. But in the morning I’m stepping up to the plate for my first colonoscopy. Yes, I’ve seen Katie Couric’s procedure on YouTube and heard her appeals on the other tube. I had even scheduled (then involuntarily bowed out of) a colorectal screening back in 2005. Nevertheless, like syndicated columnist David Barry, I’ve procrastinated for a decade. Never mind my litany of lame excuses.

I’ve been thinking about quitting.

The rabbinical students couldn’t wait for the sage’s answer. Their mentor had been asked what he thought were his greatest strength and his greatest weakness. “My greatest strength?” he paused, “Hmm. I guess it’s that I haven’t quit.” Then without hesitation he added, “My greatest weakness? Often I feel like quitting.”

I’m no rabbi, but I relate and I bet some of you do, too.

On the heels of Nurse Appreciation Week (May 4-10), I want to commend nurses in hospitals all across our country who stay by the stuff week in and week out, who refuse to turn in those resignations they frequently and understandably draft in their minds.

I’ve been thinking about melanoma, a two-letter word, the Dominican Republic, and Twitter.

Seems like my monthly newsletter comes due every two weeks. I’ve abandoned the fantasy of getting ahead and am settling these days for the illusion that I might be catching up. Speaking of two weeks, the middle two of March were medically eventful.

A mole observed during a routine physical prompted my doctor to immediately remove a hunk of flesh from my forearm. The pathology report came back: malignant melanoma cells to the depth and breadth of the sample. Within days I was in a hospital undergoing scans and going under the knife.

I’ve been thinking about contractors, physicians, presidents and the Quaids.

A successful and respected contractor took his son under his wing to teach him the trade. The father’s philosophy was simple: Build each home as if you were building it for yourself.

After several years, he assigned a project to the young man, informing him that for this one he was on his own. “I will see you when the house is finished,” he said. “Just remember, build it as if you were building it for yourself.”

The son figured that without his father watching, he could cut a few corners and no one would ever know. So he bought substandard framing materials, lower-rated insulation, and thinner dry wall than his father would have used. Paying less for the materials, he pocketed the savings.

By Richard Schaeffer, published in March 2009 issue of Health Management Technology

Mirroring the focus of the overall industry, St. Clair Hospital (St. Clair) has dedicated its efforts to ensuring patient safety. The hospital has had bar code point-of-care (BPOC) installed since March 2004, but wanted to further close the loop on medication administration. As such, in April 2007, St. Clair created an interdisciplinary team comprised of nursing, pharmacy, risk management, bio-med, IT and materials management to evaluate how smart infusion technology could further reduce the risk of medication administration errors. In addition, the team would make sure that any new technology would align with existing patient care processes that ensure the "seven rights" of medication administration (e.g., right patient, right medication, right dose, right time, right route, right reason and right documentation).

By Mike Wisz, published in March 2009 issue of Health Management Technology

Problems associated with patient identification at the point of service include inefficiencies in data entry, privacy breaches and medical identity theft, such as the fraudulent use of insurance cards.

More seriously, errors in transcribing can prevent the right patient’s record from being used in caring for that patient. The use of biometrics can improve the accuracy and integrity of care and should be considered as options to automate identification.

I’ve been thinking about waiting, workouts, and work-arounds.

None of us likes waiting. Well, I guess that depends on who’s waiting for whom. Someone observed that there are two kinds of people in our lives—people we keep waiting and people for whom we wait. For example, at lunch today it bugged me when I had to wait for a table, then a waiter. Of course, it didn’t bother me that the waiter had to wait for me to make up my mind (Don’t they get paid to wait?).

At the end of my full day, I headed for the gym. Arriving at rush hour meant I had to wait 15 minutes for an exercise machine to come open. Finally stepping aboard a treadmill, two roads diverged, and I took the road most traveled. Having waited long enough, I opted for “quick start.”

The Whole Is More Than The Sum Of Its Parts

January 2009

I’ve been thinking about books, films, Aristotle, and the importance of pulling together when it comes to achieving patient safety.

If you haven’t read best-selling author John Nance’s latest novel, you must. In Why Hospitals Should Fly, aviation-safety expert Nance maps “the ultimate flight plan to patient safety and quality care.”

Jack Silverman of St. Michaels, a fictional hospital in Denver, is a CEO driven by deeply personal encounters with medical mistakes. In his passion for mentoring others in patient safety, Silverman draws not only from his own experience as a physician but also from the invaluable safety lessons learned from the airline industry that apply to health care.

TAMPA, Fla., Jan 07, 2009 (BUSINESS WIRE) --Experts from two dozen leading U.S. health systems will share advice for the successful selection and deployment of barcode point-of-care (BPOC) systems to enhance patient safety at TerraPharma's 2009 Annual unSUMMIT for Bedside Barcoding Conference, May 6-8, 2009 in Tampa, Fla. More than 400 hospital-based healthcare professionals, including nurse managers, directors of pharmacy, clinical informaticists, directors of information systems, and senior hospital executives are expected to attend the comprehensive BPOC event.
The unSUMMIT Conference is an educational event that facilitates peer-to-peer exchange and offers hospitals an opportunity to evaluate BPOC systems and associated technologies. BPOC is well-supported by industry organizations such as The American Society of Health System Pharmacists, which has recommended barcoding technology as a highly effective means for improving the safety and accuracy of medication administration. The conference will feature presentations from several early BPOC adopters including Bon Secours Health System, Marriottsville, Md.; Brigham and Women's Hospital, Boston, Mass.; Hospital Corporation of America, Nashville, Tenn.; Lancaster (Pa.) General Hospital; Methodist Health System, Dallas, Texas; Miami (Fla.) Children's Hospital; Texas Tech University Health Sciences Center, Lubbock, Texas; and Vanderbilt University Medical Center, Nashville, Tenn. The conference agenda may be viewed by clicking here

I’ve been thinking about Sarah Palin, Tina Fey, hospital admitting, and positive patient ID.

It looks likes Tina Fey’s role as Sarah Palin has finally entered hiatus. However, don’t be surprised if Saturday Night Live flies Sarah from Anchorage to the Big Apple for an encore appearance as Tina.

Speaking of look- and sound-alikes, the U.S. Pharmacopeia tells us that over 1,400 drugs have been confused because their names look and sound alike. So much for drugs. What about patients? Do you remember Joe The Plumber? In addition to Joe Da Plumber, Joe Teh Plumber, and Joe T Plumber, Facebook lists over 400 Joe Plumbers. Whitepages.com lists 1,800! That’s nothing. The historian of the Jim Smith Society, Jim Smith, tells me over 80,000 Jim Smiths are scattered across America.

I’ve been thinking about Old Glory, Cuba, RFID chips, and bar codes entering the third dimension.

Whether you voted for John McCain or Barack Obama, I think you have to admit we are blessed in these United States. Our ballots had two pretty good options and neither was Castro. I just couldn’t talk about bar codes without first waving the flag, which, by the way, hasn’t changed much since Betsy’s iteration.

I remember the last two alterations. Do you? Hawaii’s star was sewn to the red, white, and blue on July 4, 1959—a few months after Castro took over Cuba. Alaska’s was added one year later, and nothing has been changed since.

I’ve been thinking about Europeans, Gandhi, Warhol, and me.

Last week I had the pleasure of delivering the keynote address at GS1’s Bedside Scanning Conference in Bern, Switzerland. I can’t report much from the meeting as the other lectures were delivered in French or German. However, I'm pleased to report that Swiss healthcare leaders are catching the fever.

In case you think we have bar-code point-of-care (BPOC) challenges in America, the Swiss have yet to convince drug manufacturers to apply bar codes to immediate containers, and their hospitals must still implement computerized medication-order entry before they can utilize BPOC. We have the luxury of well-established pharmacy information systems and the FDA bar-code rule behind us. Nevertheless, watch the Swiss. They will get it done, and they will do it right!

I’ve been thinking about churches, hospitals, Crocs®, and dogs.

I spent the first half of my career as a minister. One Sunday a visitor complained that the people were unfriendly. Turns out the unfriendly people he was sitting next to were also visitors.

During a recent consulting engagement that included in-depth tours of five Midwest hospitals, a number of people assumed I worked for the hospitals. It must have been the clipboard. It’s a bit like wearing a red shirt when you shop at Target®. One patient even asked me if I were a doctor. I resisted the temptation to say no, but that I did stay at a Holiday Inn Express® last night.

I’ve been thinking about booze, drugs, frogs, nails, and leaping to conclusions.

When I was in college, a professor gave our class a lesson in logic. On Monday evening a man drank enough gin and tonic that he ended up talking loudly, slurring his words, irritating his wife. On Tuesday evening she suggested he try something else. He cooperated by drinking vodka and tonic. Again his speech was slurred and his wife was annoyed. At her suggestion he tried yet another drink on Wednesday. When whiskey and tonic produced the same result, his wife saw a pattern and put her foot down. “No more tonic, mister. I don’t like what it does to you.”

What to make of the BCMA workarounds study -July 2008

I’ve been thinking about thirty-one, body mass index, automobile restraints, and how hospitals should not do bar coding at the point of care.

I dropped by Baskin Robbins the other day. It had been a while, and I had forgotten how much I enjoy nutty coconut. Nearly half my life ago, some neighbors celebrated my thirty-first birthday with a big bowl of thirty-one scoops of all thirty-one flavors—-some more enticing than others. Chocolate chip disappeared well ahead of pink bubble gum. Coincidentally, since 1979, I’ve packed thirty-one—a pound a year.

I’ve been thinking about physicians, bar coding, and WIIFM?

Recently, while pondering why the physician community has been seemingly immune to the bar-coding-at-the-point-of-care (BPOC) bug, I had an idea. Maybe it’s because they’ve been dialed in to WIIFM—not an FM radio station for Nintendo’s Wii but the abbreviation text-messaging types use to ask “What’s in it for me?”

My idea arrived while rereading Dr. Robert Wachter’s 2 May 08 blog entitled, Should Hospitals Install Bar Coding or CPOE First? Why I’ve Changed My Tune. While asking himself the question why CPOE had gained so much more momentum than bar coding over the past decade, the pioneer of hospitalist medicine suggested a theory:

I’ve been thinking about nurses, horses, guns, and hugs.

We all were infuriated when we read about the man last March who walked into a Georgia hospital and shot a nurse he blamed for his mother’s death. How could anyone do such a thing? Then I recalled a phrase from the Bible commenting on the human penchant for passing judgment on others while we do the very same things. (Romans 2:3)

Hardly anyone barges into hospitals like the man the AP article described as “armed with a three-year grudge and more guns than he could hold.” But with nurses who have been involved in unintentional medication errors, do we “shoot our wounded?” We used guns of blame, with bullets of shame, and charges of felony in the case of Julie Thao, RN, of Madison, WI.

I’ve been thinking about the power of “un” for analyzing, selecting, implementing, and using patient-safety technologies wisely.

It all begins with understanding the relative value of addressing one point of risk before another. For example, six times as many medication errors reach patients from mistakes in administering than in dispensing drugs. Therefore, hospitals stand to achieve greater safety gains by implementing bar-code point-of-care (BPOC) systems than by replacing or adding automated dispensing machines (ADMs).

I wonder if our friends at Cedars are questioning their technology priorities over the past few years. Last November, adult doses of heparin would not have reached the three babies in the neonatal unit had either ADMs or BPOC been purchased and put to work and properly used. Instead, Cedars spent a reported $34 million and countless hours over several years on developing a computerized prescriber order-entry (CPOE) system, which they canned three months after implementation. Users reported the technology created more opportunities for error than were mitigated. Oh, as valuable as CPOE can be, even the best system would not have prevented the heparin errors.

I’ve been thinking about politics, comics, and bedside scanners.

Hospital bar-coding initiatives involve numerous decisions. None are more controversial than what type of data-collection scanners nurses will take to points of care.

As intensely as political parties debate the value of smaller versus larger government, caregivers divide over the preferred size of bar-code point-of-care (BPOC) devices. Nurses on one side lobby for full-screen computers on wheels (COWs). Their colleagues across the aisle throw their support behind handhelds that fit into pockets. Of course, both parties have their limits when small reaches too small and big becomes too big.

I'VE BEEN THINKING about the plethora of viable candidates in the 2008 presidential race and the herd of caregiver ID technologies vying for the lead position in our hospitals.

I’m writing on the heels of Super Tuesday, considered the homestretch of the Republican and Democratic primaries when the derby typically narrows to two. However, today is looking more like the opening turn at Beaumont with four or five hopefuls still in the running, including candidates aiming to be the first woman, African American, POW, or Mormon to have a desk in the Oval Office.

Likewise, the healthcare user-ID technology race has fielded a large number of viable and variegated candidates—for a long time.

I've been thinking about preachers, camels, and commitments.

In response to my November 2007 column, in which I appealed to America’s hospitals to lay off the snooze button, wake up, and get on with bedside bar coding, I received a thoughtful letter from the director of pharmacy at a “moderate-sized, rural county hospital.” The affirming brother let me know that I was preaching to the choir.

However, his evangelization efforts for bar-coded medication administration (BCMA) have not yet succeeded in converting his organization, primarily because their coffers do not contain enough to fund the initiative. Being a former preacher, I was tempted to do something religious, like take an offering.

Counting Blessings and Learning Lessons

I’ve been thinking about twins, overdosing, and snooze buttons.

It was posted on the Internet, reported on CNN and written up in the LA Times. The story even popped up on the gossip tabloids at our local checkout lines. I’m talking about the drug overdosing of the twins. This time it wasn’t about the daring adventures of the Olsen look-alikes flying high on Melrose Avenue. It was about the frightening episode the newborn Quaids experienced down the street at Cedars-Sinai.

For any of you who were off the planet for the holidays, let me beam you back to reality. On Thanksgiving Sunday, Dennis and Kimberly Quaid’s newborns’ intravenous catheters were mistakenly flushed with a concentration of heparin that was 1,000 times higher than protocol. Fortunately, caregivers discovered the errors and quickly administered protamine sulfate to reverse the heparin’s harmful effects. Hospital officials reported that neither patient—thank God—suffered any adverse effects from the event. A year ago, you will recall, several babies in Indianapolis were not so fortunate.

I'VE BEEN THINKING about parents, Plymouths, pills, and packaging.

My dad’s the Zen master of documentation. A few months ago when he turned in his car keys (at age 85), there in the glove box we found the little spiral notebook in which he had faithfully registered his fueling activity (e.g., date, gallons, price per gallon, miles, and miles per gallon). I first witnessed the ritual while sitting shotgun at the Texaco in our new 1955 Plymouth.

Pops would have been great in a pharmacy. These days he has his neatly organized drawer of amber vials, blister packs, drug monographs, and a pill splitter. Methodically, he dispenses his and Mom’s pills into their little blue patient-specific SMTWTFS boxes. And, true to form, he meticulously charts each administration in the columns of another little spiral notebook (e.g., drug, time, and date). I’d wager that he has a low error rate.

I’ve been thinking about the pros and cons of utilizing radio-frequency identification (RFID) technology in hospitals.

In the middle of the Bible, a poet puts a rhetorical question to God: “Where can I flee from your presence?” A few lines earlier, he had answered his own question:

You know when I sit and when I stand;
you perceive my thoughts from afar.
You discern my going out and my coming in;
you are familiar with all my ways.

I imagine the concept of his never being out of range was at once comforting and disturbing. This reminds me of the ambivalence some hospital caregivers are feeling about the prospect of being tagged with radio-frequency chips.

I’ve been thinking... about beeps, rings, and dings.

As a kid, I couldn’t wait for weekends. Monday through Friday the parents tried to get us to start the day on NBC with Ding Dong School. Miss Frances, the Mister Rogers of the 1950s, opened each snoozer of a show by ringing an annoying handbell. The ritual almost cured me of television. However, Saturday morning’s Looney Tunes revived my confidence in the tube. Almost in a trance, my brother and I guffawed and groaned as Road Runner perpetually escaped justice. In vain we longed for just one episode in which Wiley E. Coyote would capture and devour the wiry desert fowl whose obnoxious “Beep! Beep!” drove us nuts. Somewhere tucked into all that were the ominous, but thank God, occasional flatline signals from the Emergency Broadcasting System. We were relieved they were only tests and that the Russians hadn’t pushed the button.

CLOSE IS NOT GOOD ENOUGH

I've been thinking...about patient names, drug names, look-alikes, and sound-alikes.

A few years ago, a charity mistakenly channeled my donations into the account of another donor named Mark Neuenschwander. One evening a United gate agent called me over the PA but was looking for another traveler with the same name. Not long ago, a greeting card showed up in the mail, addressed to yours truly, expressing congratulations on the arrival of a new baby—long after my five kids were grown and gone. Then there was the time an overseas client Googled my name and assumed that I moonlighted as a mean bass player doing gigs in Tampa. Hilarious, harmless mix-ups.

Hospitals in Pennsylvania increasingly are adopting health IT to reduce errors, increase efficiency and attract patients, the Philadelphia Inquirer reports.

Two South Shore hospitals now using wristband technology

Patients admitted to Milton Hospital and New England Sinai Hospital and Rehabilitation Center should take a closer look at the bracelet wrapped around their wrist.

No longer just pieces of plastic with a barely legible name on them, bracelets at the two hospitals now have an electronic bar code that could prevent a life-threatening drug reaction.

Read the entire article in the attached PDF.

I've been thinking...about alcohol, chicken, drugs, and rising intelligence quotients—more specifically about beer labels, meat packaging, medication labels, and how bar codes are getting smarter.

As seen on TV, Coors Lite bottles now come wrapped with temperature-sensitive labels. The silver image of the Rocky Mountains changes to blue when the chilled beer dips to what Coors believes is the idyllic drinking temperature. Then the label retreats to silver as it migrates back toward lukewarm.

It's a pretty cool idea. But, if you ask me, simple touch/taste tests have served us pretty well over the years. Not to mention that people argue over the ideal temperature of beer. Just ask a German.

I've been thinking...that I'm wary and weary of hearing the "workaround" excuse.

Not many, nevertheless too many in the healthcare community persist in pooh-poohing bar-code point-of-care (BPOC) systems as an effective safety measure by arguing, "Nurses just find ways to work around them." They imply this is the norm rather than the exception. Hmm. I wonder if they are using the argument to justify their own hospital's slowness to implement scanning at the point of care.

Last month, I talked with Bill Churchill, Director of Pharmacy at Brigham and Women's Hospital (BWH). A crushed ankle (from taking out the garbage) recently landed him in his own hospital as a patient. He contrasted this stay with a previous stint a few years earlier. "In the first go-around," he noted, "nurses never checked my wristband. This stay, they scanned my wristband every time. You know, it really gave me peace of mind."

I've been thinking...about the FDA's bar-code rule one year later and about the complaining that has followed.

The FDA Bar Code Rule, requiring pharmaceutical manufacturers to include bar codes on all immediate drug packages, went into full effect on April 26, 2006. The past twelve months, however, have witnessed a good bit of complaining—even by those who praised the FDA when it happened. I hear pharmacists groaning about how drug companies have dropped the ball by dropping unit-dose packaging. I hear nurses gripping about the quality of too many bar codes on manufacturer drug packages being too poor for their scanners to read. And everyone goes nuts when the package arrives without a barcode at all.

I’ve been thinking . . . about the Joint Commission’s 2008 National Patient Safety Goals (NPSGs). Along with some favorite swear words.

Last year at The unSUMMIT on Bedside Barcode Technology in Practice, the esteemed Kenneth Barker received the Way-Paver Award—”honoring the exceptional contributions of individuals and institutions that have helped clear a path and pave the way for bar-code point of care (BPOC) in America’s hospitals.” After graciously accepting the award, the world-renowned pharmacy-practice sage got to the point with a handful of words. He simply noted that over his long career, he has always argued that you start with a study. “Well,” he added, “we have done enough study on bar-coding. It’s time to get ‘er done.”

I’ve been thinking about points.

Ah, the ambiguity of the English language. Without more context, how could you possibly know what I have in mind by points?

I’m writing this article from the skies above one of the Dakotas—roughly, the halfway point between Boston and Seattle. A moment ago, I was wondering how many points I’ve amassed in my Marriott Rewards account. Right now, another road warrior is rehearsing a presentation on his laptop, the power points of which are large enough for me to read from three rows back. However, that’s all beside my point. I’m really thinking about the point of care.

The authors outline the practical considerations in developing a medication patient safety program, including establishing a blame-free environment and collecting and analyzing error data.

The Directors Forum series in Hospital Pharmacy is written and edited by Robert Weber and Michael Sanborn and is designed to guide pharmacy leaders in establishing
patient-centered services in hospitals and health systems. Another specific goal of this column is to address many of the key challenges that pharmacy directors face today, while providing information to foster
growth in pharmacy leadership

This is a policy guidance document from the Department of Health in the UK for the use of auto-identification and data capture technologies such as bar codes across the NHS.

HMT reporter Richard Rogoski investigates how bar codes and drug information databases are helping to reduce medication errors. The article introduces us to hospitals that not only have invested in new technologies, but now regularly review and update their policies and procedures pertaining to the ordering and distribution of medications.

Link: http://www.healthmgttech.com/archives/0207/0207manic_medication.htm

Kerry Clark, CEO of Cardinal Health, in an interview discusses how new technologies should be employed to prevent hospital deaths from drug errors and hospital-acquired infections. Clark says Cardinal already works with some solutions, including a medication dispensing system, which verifies that when the medication is drawn at the nursing station, it is checked against the patient record, confirming time and dose. The New York Times (2/17)

This article discusses the weaknesses inherent in using the five rights for medication use as absolutes and suggests that they instead serve as broad goals to support safe medication practices.

Source: ISMP Medication Safety Alert! Acute Care Edition. January 25, 2007;12:1.

I’ve been thinking Seattle, New York, Indianapolis and Madison.

I spent the too-be-forgotten Father’s Day of ‘95 on the front row—just past the dugout on the third base line—at a Seattle Mariners’ baseball game. It turned out to be the opportunity of a lifetime. Three balls were fouled my way.
I dropped the first and took the heat—from my five kids, no less. This hardly boosted my confidence for the next grounder, which I also dropped. While one understanding dad offered me his glove, “Here buddy, just in case,” other nearby fans ragged on me. You guessed it—I bobbled the third. The entire merciless crowd booed when the scoreboard flashed “FAN ERROR.”

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.

A tool used by nurses to report interrcepted medication issues.

A sample letter built from BPOC system compliance reports that encourages nurse managers to work with individuals identified as having poor scanning complinace.

A tool to determin NOW doses for all medication dosage forms (i.e. IV, PO, SC, IM).

Case study: By instituting bar code technology from the pharmacy to the patient's bedside, Opelousas General Health System reduces its medication error rate.

This white paper will explain why a dedicated thermal printer is the superior choice for bar code label printing in hospitals.

A PowerPoint overview of the VA's history with wireless PDA software.

This article describes a multidisciplinary effort across the Sisters of Mercy Health System (Mercy) that promises to have the greatest impact on patient safety ever achieved in Mercy's history. Mercy Meds, a comprehensive
transformation of the medication use process, incorporates technology, strategic partnerships, supply chain management and improved work processes to bring an enchanged level of safety and efficiency to the medication process. In summary, the initiative seeks to ensure the five rights of medication
safety: the right dose of the right drug through the right route at the righ

A PowerPoint presentation of detailed eMAR lessons learned including nursing impact, quality control implications, pediatric recommendations, respiratory therapy lessons, and infection control practices.

A PowerPoint describing the first 5 years of eMAR experience within HCA hospitals.

A PowerPoint overview of the HCA experience with barcode point of care technology.

PowerPoint Presentation of BPOC background and Centennial Medical Center's experience to date.

A seven-part series of articles on the deployment of a 5 Rights Medication verification system at St. Clair Hospital, in suburban Pittsburgh, PA.
Part I - The Decision: Move to 5 Rights, or Remain Wrong
Part II - The 5 Rights Platform: Carts or Handhelds
Part III - Deployment in the Wireless Environment:The Burrito Effect
Part IV - Refinements: Discoveries and Refinements The Real World Live Environments
Part V - Results: Analyzing the Post Activation Data
Part VI - The Future: What's Next
Part VII - To Err is Human: To some extent

The purpose of this study was to assess the impact of bar code verification (BCV) on medication errors in a small private hospital.

Since hospital-based repackaging centers are rare, studies of design,
implementation, quality control, and generation of medication errors are
rare. The objective of this study was to identify errors generated in the repackaging center and to identify and implement system improvements to
reduce future errors.

Results of the 2005 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented.

Conclusion. Safe systems continue to be in place in most hospitals, but the adoption of new technology is changing the philosophy of medication distribution. Pharmacists are continuing to improve medication use at the dispensing and administration steps of the medication-use process.

The Pharmacist Toolkit for Implementing a Bar Coding Medication Safety Program is provided by the American Society of Health-System Pharmacists Research and Education Foundation and was made possible by an unrestricted educational grant from Omnicell. To begin development of the tool, in August 2003 the ASHP Foundation assembled a panel of experts on the application of bar coding to prevent medication errors. This panel established the initial framework for this document and served as reviewers as content was developed. Writing, editorial, and project management services were provided by IDentityHealth, Inc. of San Diego, CA.

The purpose of this worksheet is to guide the hospital in calculating the potential savings resulting from the implementation of technology to reduce medication errors. The amount of savings will vary, depending on organizational characteristics and the technologies under consideration. Suggested users include senior management and department leaders involved with product evaluation, selection, and purchase.
The results of this worksheet can help to direct the hospital toward technologies that offer the most value for the organization in terms of medication safety and financial return. Sources of information would include the results of the organizational assessment and IT vendors.

This table is intended to help the hospital assess its needs (i.e., features that are "must have" versus "nice to have") and evaluate the capabilities of competing products. It can be used by a medication error prevention implementation team that is charged with (1) determining the hospital's priorities for interventions to prevent medication errors and (2) selecting vendor products that can meet those needs.

The purpose of this checklist is to help the hospital plan for the implementation of new technologies and record its progress over time. It is meant to be used initially by senior management and departmental leaders, and then updated regularly by a multidisciplinary implementation team.

This tool is intended to help the organization assess the various processes involved in the delivery of medications and identify areas that would benefit from technological support. It may be used by senior management and departmental leaders at each step of the organization's medication use process.

A comprehensive annotated bibliography of BPOC-related publications.