I’ve Been Thinking that I’m wary and weary of hearing the workaround excuse

June 1, 2007 | In: I've Been Thinking

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.”

Neither Bill nor I would suggest that workarounds do not occur. Research at one university hospital, during the early days of BPOC implementation, revealed their nurses were working around the proper wristband-scanning process nearly 5 percent of the time. From my conversations with other hospitals, this is not uncommon during the early stages of utilization. And while we all agree that 5 percent is too high, I wonder if those who jump to downplay the value of bar-coding are not the same folks who tend to say the glass is half empty about a lot of things.

Interestingly, the same university health center utilized the observational method to conduct pre-implementation studies in which nurses knew they were being watched. To the hospital’s chagrin it was discovered that prior to implementing bar-code scanning, nurses were failing to read wristbands for positively identifying their patients a whopping 85 percent of the time. Does that sound like workarounds to you too?

Then I wonder, would the bar-code critics rather have the nurses who care for their loved ones work around the positive ID step 85 percent of the time or 5 percent of time?

If you ask me, the bar-code glass isn’t half empty—it’s 95 percent full. Oh, I’m not suggesting that 95 percent scan rates should satisfy us. There should be no working around the process, unless there’s an emergency situation in which good clinical judgment requires it.

Churchill, who was the beneficiary of a safety process he helped engineer agrees. Frequently, he reminds his colleagues in Boston that BPOC is “the right thing that should be done the right way.” Workarounds must be resisted, monitored, and addressed.

So, while I will keep on encouraging the elimination of all improper workarounds, I’m not going to let up on telling the world, including the naysayers, about the impact that bar-coding is having on patient safety. Someday, they and their organizations will buy in—hopefully before they find themselves being admitted as patients in their own hospitals.

What do you think?

Mark Neuenschwander

Copyright 2007 The Neuenschwander Company

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