Friday, October 14, 2005

We Fish and See

It's called an automated medication dispensing system, and on rare occasions it actually does dispense meds. Most of the time, however, it just keeps the medications quixotically locked up so that nobody can get them.

That can be a real time-waster. Suppose you have a patient who complains of a mild headache and requests some tylenol, which they sometimes take at home for fever or mild ailments. Easy, that. I can just go get some out of a medicine cabinet, right?

Not exactly.

If it had not already been specified as an as-needed med by the doctors, then technically I would be required to call a doctor or resident and get an order for acetaminophen. Then I would fax the order to the pharmacy, where some poor drone would copy it into the computer database that controls the automatic medication dispenser, which of course hasn't yet dispensed a freaking thing.

After all that I would then give the patient the med, assuming that I did not have to wait in line while other nurses removed items from the automatic dispensing machine. Ten nurses, two machines.

In many cases I feel I could simply leave The Great Southwestern Muffin Factory and walk to a local pharmacy, buy the stuff over-the-counter myself, walk back and give it to the patient in less time.

But ironically, that would be inefficient.

It's probably a lot safer than leaving things in cabinets, though.

Once in a great while you hear or see some kind of "angel of death" story involving an errant (completely bat-crap wacko) nurse who kills their patients. Charles Cullen was probably one of the recent worst cases, but history is full of them.

Generally speaking, hospitals are very meticulous about record-keeping and statistics, and it is through such that these killers are found out and prosecuted. I cannot help but think that someday such a person will be apprehended because they get caught trying to fake out a Pyxis machine.

Actually this is the first time I have considered this possibility, because usually I am just plain annoyed at the machine for slowing me down. But I saw an interesting movie after I came home from work last night and everyone else was in bed.

Charming Billy, an independent 1999 film, was on one of those groovy three-digit cable stations. It was a rather disturbing but excellently acted and scripted story about a twenty-something man who climbs a rural water-tower and starts shooting people and cars. The movie unfolds in poetic flashbacks.

While watching it I thought that it is amazingly sad how much devastation and ire can be manifested by just one person.

I was going through my blogroll while watching this film, and among the links I read about the trouble Head Nurse has recently had with some likely dangerous student nurses.

There are only a very few bad nurses, but they come from somewhere, now don't they? And thanks to at least Head Nurse and others like her, they now come from one less place.

Myself, I have never had the pleasure of canning a nurse or student who I deemed dangerous, but someday that kind of luck could run out, and I will.

I have known three nurses who lost their jobs for either diverting drugs (a nurse supervisor who took demerol for himself) or for using on the job, like coming out of the bathroom sniffling and giggling. That was back before freebase and crack became prevalent . I suppose crystal meth would be more suspect these days.

Nurses need all the help we can get from one another, and killers and drug addicts do not make dependable coworkers. We tend to shove out personalities we do not like on the team. These people go from job to job, or they get promoted out to specialty ICU jobs with exposure to more critical and therefore more vulnerable patients.

I like the team of nurses I currently work with, and I openly brag about them in non-anonymous situations. I know that if difficulty arises they "have my back," and I in return pledge, sometimes outloud, that I too have their backs covered.

Literally, sometimes, like while waiting in line at the Pyxis machine to get some tylenol for a warmish head-achy patient.


Eli Blake said...

Your post gave me two thoughts.

The first, about how one idiot can change the whole system, has to do with about how people now sometimes have to remove their shoes at the airport because of Richard Reed. Or how you can no longer buy already stamped envelopes (a great convenience, really) at the post office because of Ted Kaczynski (and HE never used stamped envelopes at that, but they wanted to make sure that there was no way someone could mail an item without either a peel off or licked stamp so that there would be DNA traces on it). I remember the college I used to work at, and we used to post student grades (with adequate identity protection) in the hall so students could come by and learn what they got. Then one time some half drunk jerk came by during off hours when the school was locked up, and got frisky with the security guard, demanding to be let in, so they changed the policy for everyone so that no one could post grades.

The second thought was this: If you had a psychotic nurse who wanted to kill people, why would (s)he bother with the machine at all? You can certainly find substances that could kill all over the place, especially if you have studied enough biology and chemistry to realize it. I have a degree in chemistry that is twenty years old (and I haven't used it much since) and I'm sure that even I could probably walk into the nearest department store and find at least a dozen things someone could give to a sedated patient that would produce a fatal reaction, either immediately or by repeated application over time. I'm sure that you could probably find two or three times as many, if you wanted to. The idea that this machine will prevent this from happening is ludicrous.

HypnoKitten said...

I'm just backreading you this morining - I've been so busy with things.

At our muffin factory an RN can write a nursing order for tylenol or maalox. Those are the two I know so far. We write the order, fax it and it's put in the machine in a minute or two. Much easier than trying to find that patient's doc.

We've also got our own pharmacist who sits up at a desk near the main nurse's station. He can clarify orders, change medications if non-formulary meds are written for, and get stat stuff up to us a lot quicker.