Articles and Studies

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.