Saturday, September 26, 2009

Trolling for patient safety in social media

People are asking lots of questions about social media (SM). More specifically, I think, we're wondering whether Facebook, Twitter, and blogs have meaning beyond what I've recently counseled my 21 year old daughter to beware of: trolling for amusement.

SM can knock on the door of its evil cousin, "addiction." It has, on occasion, claimed rather large chunks of my life in a way I failed to notice or care about while engaged. So am I a Twaddict? A Blogopath? Am I locked in to Linked-in?

Life is meant to be lived. Not mindlessly thumbing through electronic messages in hopes of finding something more interesting than what's happening where you are. So I've been reflecting about whether time spent at social networking sites can be counted as really living?

I don't know for certain that social media is "life," but I think it reflects life. More specifically, it's a barometer of culture. As a person who follows how culture in healthcare organizations impacts safety very closely, I find that SM opens a window into experiences and settings that are otherwise closed. Since you can only learn--individually and collectively--from mistakes and near-misses that you know about, I think greater transparency is among the greatest gifts SM offers the discipline of patient safety.

Here are just a few examples that captured my attention in the past few months. Since this is not a forum to fully deconstruct each event, I'm titling each to show the behavior or belief that undermines safest practice:
  • It's okay to carry things that will be injected into patients' veins in the same manner as a Bic pen: A promising young nurse shares stories about her entry into the nursing profession. One day, she photographs what she carries in her pocket. Scissors, tape, "flushes," and pens are among the things she finds helpful to store there.

  • We all have nights from hell: A seasoned intrapartum nurse describes a busy shift where she cares for multiple high-risk patients, all of whom are receiving high alert medications (those highly likely to cause harm if used in error). Staffing inadequacies and a pervasive "get 'r done" culture prevent post-procedure medication and patient monitoring. Everything turns out okay in the end.

  • Smart people don't make stupid mistakes: A resident caring for a patient receiving intraoperative dialysis takes a picture of the machine used to perform dialysis. She questions whether it's necessary to have adjunct labeling ("Dialysis Only. Do Not Drink") affixed to the front. And she asks this in a way that suggests this photo may wind up in an upcoming collection of "Darwin Awards."

People share their stories and experiences in SM venues in ways that often remove standard filters, many of which we rely on to be successful (or at least functional) in "real life." Bloggers and tweeps are not in "inspection mode," and they're not usually engaged in defensive posturing. Most accounts come from regular people, telling stories about how they take on the business of providing care. Details about obstacles faced, choices made, and opinions expressed reflect the culture of healthcare.

I saw this from Dr. Val, tweeting from a live speech by Francis Collins last week:

Collins: If you want to find a cure for cancer, you don't need to just research cancer. The answers may come from somewhere else. #RSOS.

So, too, with curing what ails healthcare.

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