Comments for Point of Care Forum

Comment on I’ve been thinking about bird feeders, golf clubs, and automated drug-dispensing cabinets. by Paul Greenall

Paul Greenall — Thu, 09 Feb 2012 20:43:35 +0000

On our camping trip, we took all of our supplies and wrapped them all up in a burlap bag with rope and wire to ensure that the opening was secure. We then secured one end to a stump and hoisted the bag through a notch in a tree and hung it over the fast flowing water. We wrapped the rope with barbed wire and other protruding objects so that nothing could climb on the rope without extreme difficulty (if you know what I mean) and placed a large round piece of plastic around the rope as it decended down to the burlap bag for extra security.

In the morning, we found the empty burlap bag with all of the contents missing, about 3-4 hundred meters down river. The bottom of the rope near the first knot had been bitten through as well as the bottom of the bag.

There’s a message here about more than one way to skin a cat I think.

Comment on I’ve been thinking about bird feeders, golf clubs, and automated drug-dispensing cabinets. by Celeste Sickorez

Celeste Sickorez — Mon, 06 Feb 2012 21:27:22 +0000

We built a wooden triangle and attached it to the second floor of the house. Then we hoisted 3 birdfeeders up on pulleys. The pulley ropes are hooked on the house at a reachable level for people. The feeders are too far up from the ground and too far down from the roof for the squirrels to access. Refilling is just a matter of unwinding the pulley ropes, putting in the seed, and hauling the feeders back up.

Comment on I’ve been thinking about magnetic resonance imaging, sleeping bags, allergies, and great hospitals. by mark

mark — Thu, 26 Jan 2012 01:43:57 +0000

That’s funny. They could pay me 700 DOLLARS a minute to sit still under an MRI and that wouldn’t even work.

Comment on I’ve been thinking about magnetic resonance imaging, sleeping bags, allergies, and great hospitals. by Jay Andres

Jay Andres — Wed, 25 Jan 2012 19:28:55 +0000

Had my first one a few weeks ago at age 55 for what turned out to be a shoulder impingement. I remember hating dogpiles back in my football days, however this was much worse. Here in Dubai they are not fond of providing anti anxiety drugs, however they did have a nice lady from the subcontinent who makes 700 dirhams a month, who helped out. Normally she is a janitor, except when some one flips out during an MRI. She is then called upon to talk you through it. She does not provide any advice, she simply talks and talks and talks. Her rudimentary stats revealed that well over 50% of the patients need here services. She even provided me some stats by nationality. She claimed to be able to spot her future patients as soon as they walk through the door. All this for 700 Dirhams a month. Look it up, it is not much, but she sure does enjoy her work.

Comment on I’ve been thinking about magnetic resonance imaging, sleeping bags, allergies, and great hospitals. by Michael McDaniel

Michael McDaniel — Thu, 22 Dec 2011 21:19:05 +0000

Yep, a few weeks ago I found out via an aborted MRI that I am NOT going to be in a tube that small, awake, ever again. From that point on I’ve continued to have small shudders just remembering opening my eyes and seeing the tube just inches in front. There, I just shuddered again! It was also for a suspected torn right rotator cuff. I’ve decided to just live with it. Over the past few months my range of motion has gotten better and the pain, less.

Comment on I’ve been thinking about magnetic resonance imaging, sleeping bags, allergies, and great hospitals. by Dennis Tribble

Dennis Tribble — Sun, 27 Nov 2011 16:23:52 +0000

Mark,
I, too was surprised by my claustrophobia when enduring an MRI. I made it through, but the neurosurgeon complained bitterly about the poor quality of the image. Apparently I squirmed. What an amazing thing to learn about one’s self at our age!

I also had an MRI for a torn rotator cuff. I elected not to have the surgery, but did physical therapy instead until my insurance called “hold! enough!” I still think it was the better choice for me. What I remember, though, was watching on the fluoroscope as they injected my shoulder with steroids for some immediate relieve and being able to see both 4″ tears in my rotator cuff. On a fluoroscope!! If they were that visible, why did I have to endure an MRI??? It makes me wonder how often we swing the heavy hammer when a light tap with a small mallet might work just as well.

Dennis

Comment on I’ve been thinking about lawnmowers, eye drops, smart phones, and glue. by Mark Neuenschwander

Mark Neuenschwander — Fri, 11 Nov 2011 22:39:46 +0000

Amen brother. Thanks Dennis.

Comment on I’ve been thinking about lawnmowers, eye drops, smart phones, and glue. by Barbara Olson

Barbara Olson — Thu, 10 Nov 2011 05:15:10 +0000

Thank you, Mark and Dennis. What’s wrong, why, and what you can do about it on one screen (in a font size middle-aged eyes can read). Plus a story or two for a smile.

Comment on I’ve been thinking about lawnmowers, eye drops, smart phones, and glue. by Dennis Tribble

Dennis Tribble — Wed, 09 Nov 2011 19:44:13 +0000

Mark,

All this underscores the futility of relying on human diligence in a world that is now over-populated with choices.There are a variety of extremely well-researched (not to mention old) publications from high-reliability industries (like nuclear power) that provide insight into the point at which human diligence fails. That number is surprisingly high (like between 3% and 10%) even for highly-trained professionals.

What this means is that strategies that ultimately rely on human diligence are also likely to fail. Tallman lettering cannot create the huge number of visually recognizeable names needed to clearly differentiate products; nor are there enough colors that can be readily identified when standing alone (as opposed to being compared to another color). These strategies are band-aids on a problem; they may reduce some of the pain, but they cannot, will not measureably move the needle on medication safety.

This is why BCMA (or BPOC, or BMV… take your choice) is so important. The bar code scanner, and the software behind it are incredibly literal, and have no mental processes that can cause them to see DUREZOL (or the number that represents it) when they were supposed to see DURASAL. The scanner, and the software behind it, are capable of diligence that is well beyond what we as humans can achieve.

Note that I said capable. What remains as a significant roadblock to achieving that capability is the incredble amount of work needed within each and every institution to maintain a current and complete library of the bar codes they encounter (or the NDC’s within those bar codes, if the software is smart enough to isolate and use it).

Indeed, at a webinar on RxNorm not long ago, Stuart Nelson effectively indicated that the FDA had abandoned all pretense of knowing what NDC’s are in the field or what they represent. They no longer even attempt to keep their public database current.

That is why I am urging everyone who chooses to comment on the FDA query about using 2-D bar codes to include commentary on the vital need for a FREE, reliable, and current database of NDC’s currently in the supply chain. I did…

Dennis Tribble

Comment on Fingers crossed as FDA considers modifying drug bar code packaging rule by Noosh

Noosh — Thu, 27 Oct 2011 04:43:04 +0000

FDA to reassess BAR CODE TECHNOLOGIES FOR DRUGS BIOLOGICAL PRODUCTS. This is a great opportunity for improving bar-code medication administration safety system.

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