7 ms·

I am a former pharmacist who has moved into technology consulting. I'm in the UK so forgive the UK focus of my response. It is in fact the role of a pharmacist

by flarg 10y ago

I am a former pharmacist who has moved into technology consulting. I'm in the UK so forgive the UK focus of my response. It is in fact the role of a pharmacist to reduce medication errors - and this is achieved through a series of checks - largely focussed on asking 'is this the right medicine and dosage for this patient and the condition to be treated?' and 'has the correct medicine, dosage and dosage form been dispensed?' Errors tended to occur outside of pharmacy's area of control; in theatres to where pharmacists often have little access, in ward settings where medicines are administered in sometimes noisy and chaotic environments, in clinical teams where pharmacists are not allowed to have a presence, and indeed in the modern NHS where pharmacy staffing levels are severely reduced. A technological solution is possible - based on the concept of checklistbundles, patient medical and medication record systems and image scanning technology - but it is usually hard to sell clinicians on the idea of a check-list never mind anything else. Until there is a true incentive to change practices around medication administration (i.e. unlimited fines) this will always be a hard thing to change.

noir_lord 10y ago
The tragedy here is that checklists where invented for dealing with complex common situations under stress (iirc they where popularised not sure if invented in the modern form as a way to allow pilots to fly a much more complex aircraft than preceeding models[1]). http://www.atchistory.org/History/checklst.htm http://www.atchistory.org/History/checklst.htm
- flarg 10y ago
  Indeed - the corresponding research into checklistbundles indicated that they would be quite effective; but I think the lack of anything like 100% uptake is due to the lack of appropriate technology to easily create, maintain and utilise checklistbundles.
  - SapphireSun 10y ago
    I really doubt that... I'm pretty sure the reason for lack of uptake is organizational and social in nature. A checklist is the simplest thing in the world. I can make a checklist right now! - Write comment (Check!) - Check grammar and spelling (Check!) - Scrub abusive language (Check!) - Click "reply"
    - flarg 10y ago
      Check-lists in medicine (and real life) are a lot more complex depending on the protocol and the patient and are more akin to complex business process flows - around which a whole industry has grown. A colleague in psychiatry spent 12 months designing a simple checklist and data collection form for initial patient evaluation.
      - SapphireSun 10y ago
        Sure, but that doesn't sound like an impossible thing to deal with. There are many activities we undertake that are far more complex (collecting taxes for one!) and not every process is hard, you could hit the easy ones first. It's a question of will.
        noir_lord 10y ago
        Will in one sense, herding cats in another ;).
        leonth 10y ago
        It's a question of resources as well. Adding checklists means more time and audit needed. Let's say something initially took 30 secs (due to the muscle memory prowess of the health workers) but by using a checklist it gets down to 45 secs - a 50% increase in latency. If this process is done 10000 times a day (a respectable number if you consider high-volume processes like administering a drug): * you might have just increased manpower requirements across the board by about 50% * you might have just caused patients to wait over the phone 50% longer, or queue to get their medicine 50% longer, or wait for the discharge process to finish 50% longer...
  - petra 10y ago
    >> but I think the lack of anything like 100% uptake is due to the lack of appropriate technology to easily create, maintain and utilise checklistbundles. How would such technology in ideal form would be like ? and how do current practical implementations look like ?
    - noir_lord 10y ago
      The ideal would be an on-screen overlay (HUD, MS Hololens) which has voice control, "Insert IV, checklist", it pops up, "Completed: Swab", "Completed: Step2". Have the system then sync that to a central system so you have a real time status of every procedure/drug/intervention administered to a patient, voice control means no issues with hand contamination, paperwork to carry around (and forget) etc. I think we'll probably get to that at some point especially if sub-vocal voice recognition catches on.
deleted 10y ago
[deleted]
athenot 10y ago
This is where patient health litteracy comes in. If the patient (or better: a trusted helper) has a plan going in of what's going to happen, what are the risks, what are the mitigations if complications arise, then they can follow along those delivering the care. Sure, caregivers can resent the patients asking too many questions, but this is more about setting up a collaboration and understanding the rationale behind decisions. This catches all sorts of errors that arise; it's not that the caregivers are incomptent, but they are human.
- harrumph 10y ago
  >then they can follow along those delivering the care. I don't doubt your intent is good, and I like to promote literacy in care as well, but I really really think the notion that supervising one's own care is a good idea is completely out to lunch. The pain, discomfort, emotional trauma, precarity -- these very real things tend to put even the best manager off one's game.
  - DanBC 10y ago
    Medical error doesn't just happen in emergency care. One of the most important questions you can ask your doctor before getting treatment (whether that treatment is surgery or medication) is "What happens if we don't do anything? If we just watch and wait?" Here's a short film about involving older people, and their carers, in their healthcare when they enter a carehome setting. This work focusses on a medication review involving a doctor, a pharmacist, the patient, and their carers. The reviews save money, increase quality of life, and reduce risk of death by suicide and accidental death. http://www.health.org.uk/pills http://www.health.org.uk/pills
    - harrumph 10y ago
      Thanks for this. I'd say these are reviews taking place in a clinical setting and geared toward generating a care plan with a time frame of some length. Under these conditions, we could expect a patient to be laboring under the fewest possible distractions and as such be the best candidate for supervising one's own care. But it is seriously wrong to assume the patient will continue to act akin to a corporate employee bloodlessly toiling on a project at work. It is far more likely that the patient will at some point begin to act like a person with discomfort, with all the accompanying bewilderment, skepticism, confusion, hypersensitivity, etc. This reality needs to be honored, not waved away. Again, I do advocate for educated and engaged patients, but I totally reject the idea that systematically these patients are to be depended upon for engagement in their own care to the degree that any medical errors can reasonably be precluded by such engagement. Not only does it fly in the face of psychological realities of patients, it appears to me to be an ugly slippery slope toward the direction of general victim-blaming and "externalization" that the corporate ethos is so well known for.

by flarg 10y ago

noir_lord 10y ago

The tragedy here is that checklists where invented for dealing with complex common situations under stress (iirc they where popularised not sure if invented in the modern form as a way to allow pilots to fly a much more complex aircraft than preceeding models[1]). http://www.atchistory.org/History/checklst.htm http://www.atchistory.org/History/checklst.htm

flarg 10y ago
Indeed - the corresponding research into checklistbundles indicated that they would be quite effective; but I think the lack of anything like 100% uptake is due to the lack of appropriate technology to easily create, maintain and utilise checklistbundles.
- SapphireSun 10y ago
  I really doubt that... I'm pretty sure the reason for lack of uptake is organizational and social in nature. A checklist is the simplest thing in the world. I can make a checklist right now! - Write comment (Check!) - Check grammar and spelling (Check!) - Scrub abusive language (Check!) - Click "reply"
  - flarg 10y ago
    Check-lists in medicine (and real life) are a lot more complex depending on the protocol and the patient and are more akin to complex business process flows - around which a whole industry has grown. A colleague in psychiatry spent 12 months designing a simple checklist and data collection form for initial patient evaluation.
    - SapphireSun 10y ago
      Sure, but that doesn't sound like an impossible thing to deal with. There are many activities we undertake that are far more complex (collecting taxes for one!) and not every process is hard, you could hit the easy ones first. It's a question of will.
      - noir_lord 10y ago
        Will in one sense, herding cats in another ;).
      - leonth 10y ago
        It's a question of resources as well. Adding checklists means more time and audit needed. Let's say something initially took 30 secs (due to the muscle memory prowess of the health workers) but by using a checklist it gets down to 45 secs - a 50% increase in latency. If this process is done 10000 times a day (a respectable number if you consider high-volume processes like administering a drug): * you might have just increased manpower requirements across the board by about 50% * you might have just caused patients to wait over the phone 50% longer, or queue to get their medicine 50% longer, or wait for the discharge process to finish 50% longer...
- petra 10y ago
  >> but I think the lack of anything like 100% uptake is due to the lack of appropriate technology to easily create, maintain and utilise checklistbundles. How would such technology in ideal form would be like ? and how do current practical implementations look like ?
  - noir_lord 10y ago
    The ideal would be an on-screen overlay (HUD, MS Hololens) which has voice control, "Insert IV, checklist", it pops up, "Completed: Swab", "Completed: Step2". Have the system then sync that to a central system so you have a real time status of every procedure/drug/intervention administered to a patient, voice control means no issues with hand contamination, paperwork to carry around (and forget) etc. I think we'll probably get to that at some point especially if sub-vocal voice recognition catches on.

deleted 10y ago

[deleted]

athenot 10y ago

This is where patient health litteracy comes in. If the patient (or better: a trusted helper) has a plan going in of what's going to happen, what are the risks, what are the mitigations if complications arise, then they can follow along those delivering the care. Sure, caregivers can resent the patients asking too many questions, but this is more about setting up a collaboration and understanding the rationale behind decisions. This catches all sorts of errors that arise; it's not that the caregivers are incomptent, but they are human.

harrumph 10y ago
>then they can follow along those delivering the care. I don't doubt your intent is good, and I like to promote literacy in care as well, but I really really think the notion that supervising one's own care is a good idea is completely out to lunch. The pain, discomfort, emotional trauma, precarity -- these very real things tend to put even the best manager off one's game.
- DanBC 10y ago
  Medical error doesn't just happen in emergency care. One of the most important questions you can ask your doctor before getting treatment (whether that treatment is surgery or medication) is "What happens if we don't do anything? If we just watch and wait?" Here's a short film about involving older people, and their carers, in their healthcare when they enter a carehome setting. This work focusses on a medication review involving a doctor, a pharmacist, the patient, and their carers. The reviews save money, increase quality of life, and reduce risk of death by suicide and accidental death. http://www.health.org.uk/pills http://www.health.org.uk/pills
  - harrumph 10y ago
    Thanks for this. I'd say these are reviews taking place in a clinical setting and geared toward generating a care plan with a time frame of some length. Under these conditions, we could expect a patient to be laboring under the fewest possible distractions and as such be the best candidate for supervising one's own care. But it is seriously wrong to assume the patient will continue to act akin to a corporate employee bloodlessly toiling on a project at work. It is far more likely that the patient will at some point begin to act like a person with discomfort, with all the accompanying bewilderment, skepticism, confusion, hypersensitivity, etc. This reality needs to be honored, not waved away. Again, I do advocate for educated and engaged patients, but I totally reject the idea that systematically these patients are to be depended upon for engagement in their own care to the degree that any medical errors can reasonably be precluded by such engagement. Not only does it fly in the face of psychological realities of patients, it appears to me to be an ugly slippery slope toward the direction of general victim-blaming and "externalization" that the corporate ethos is so well known for.