Saturday, May 30, 2009

Jon and Kate: I think I'll medicate!

Call me silly, but I'm always surprised when highly predictable events happen. Take the high-profile dissolution of Jon and Kate Gosselin's marriage.

Under circumstances that can best be described as childbearing Yahtzee, a young couple in rural Pennsylvania manage to add six-of-a-kind to the deuce they rolled in the first round of play. Shortly thereafter, they score a reality TV series, adding producers, cameramen, photographers, hired help, speaking engagements, investment portfolios, and book tours to the primary task of raising eight humans, six of whom--unfortunately and largely without precedent--share the same developmental stage.

She thrives, leaving the stay-at-home-mom-who-happens-to-drive-a-church-bus image behind and morphing into someone who might be credibly cast on "Real Housewives of Punxsutawney." He begins to resemble Jim Carey in "The Truman Show." The marriage crumbles. Who knew?

Marriage in the U.S. doesn't have great odds to begin with, and marriages with high-order multiples have higher failure rates than others. But like Captain Renault in Casablanca, we're shocked, shocked to find that gambling is going on in here!

The denouement of Jon and Kate has left me thinking about medication use, a topic that could reasonably be expected to arise in an upcoming episode. So, in the short window of clarity that followed the "ah-ha" moment when I learned Jon and Kate ain't great, I jotted down eight things about medication safety that you, too, probably knew all along. (Apparently, we should be shocked, shocked to find that gambling has been going on here!)

1. If you routinely identify patients using 2 distinct identifiers and engage them in the care that's about to occur, you're less likely to give a patient the wrong medicine, conduct the wrong test, or perform the wrong surgery.

2. If you make drug information available to clinicians on the front line (preferably in a mode that's as easy-to-use as an iPhone, not a dogged-eared text from an earlier century), the clinician administering drugs will be able to become familiar with, and actually double check, unfamiliar drugs and doses before administering them.

3. If you say "fifty" (without saying "five-zero") over the telephone, you're likely to be heard to say "fifteen." "I'll be there in 15 (or 50?) minutes" is not as much of a problem as, "Give her 15 (or 50?) units of insulin." Break multiple digit numbers into their simplest form, say and spell drug names, and read back and verify high-stakes information that's transmitted verbally.

4. 1400 commonly used drugs look like or sound like another one. These similarities regularly cause competent people to select an unintended drug from a computerized pick-list or mis-hear a drug as its sound-alike cousin. If you include the purpose for the drug on all orders or written prescriptions, this information allows another knowledgeable professional (like a pharmacist or nurse) to detect and derail a look-alike, sound-alike (LASA) error since few members of LASA drug name pairs are used for the same purpose.

5. If balsamic vinegar and olive oil come in similar containers, it's easy to kill a quesadilla. How drugs are stored at work matters, too.

6. If something can be attached to something else, someone will attach it. Good for tinker toys, Legos, and jigsaw puzzles. Bad for oral medications in parenteral syringes and pressurized B/P tubing connections that are compatible with IV lines. If you can't put diesel fuel into your gas tank by mistake, why don't we have similar safeguards in place at work?

7. If the lighting is bad in a restaurant, you have trouble reading the menu. If the lighting is bad over automated drug dispensing cabinets, your front line is going to have trouble reading the labels of the drugs they remove from them.

8. The average age of a nurse is around 50 years old. Most drugs that are given today were boiling in a cauldron somewhere when we took our boards. If you define how risks associated with high alert medications and LASA drugs are managed in individual care settings within your organization and teach these strategies to nurses (and others who handle drugs), you will prevent mistakes that have been made elsewhere from occurring where you work.

I hope you find these 8 to celebrate, agitate, and advocate, eight things that will help you take care when you medicate!


Anonymous said...

As a health educator, I find this blog to be one that inspires me with facts I can use, heavily laced with humor...It's well written and I love it... Thank you Barbara Olson, for doing what you do.
Linda Harris
Portland, OR

Barbara Olson, MS, RN, FISMP said...

Thanks for the kind words! Feel free to suggest specific topics and let me know what helps you help the people you serve.


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