Bolus of Common Sense

We had a patient that was aspirating.  The concern was whether or not it was tube feeds.  Before we would add some food coloring to the tube feeds and then see what color the mucus was that the patient coughed up.  Now we cant because somebody wrote a paper that it might cause a reducing agent problem.  I tried to explain to the nutritionists that we were just going to use the same stuff that was in the cupcakes in the cafeteria but they wouldn't hear of it.  All they said was the potential danger of the dye.  In my own retaliatory manner I flooded them with case reports where tube feeding was accidentally run into central lines because it is the same color as the lipids in the TPN.  They didn't think it was funny.  I solved the problem by putting Gator Aid in the tube feed and sure enough he was aspirating!

This led me to wonder.  We are always trying to be sure the wrong medication is not given to the wrong patient.  Why don't we color the medications so that even when they are in the syringe of the bag we know that something is wrong.  After all, patients take pills that are different colors.  Make morphine blue, decadron yellow, ancef green and so on. That way when you walk into the room you know hey these are the meds he is on.  Oh, never mind, that makes common sense.

Hand Caught in the Cookie Jar

We set a new record last month in the medical center.  Six  times maintenance had to be called to cut the top off a sharps box to free the hand of someone who was trying to get the used syringes for the last drops of the narcotics contained within them.  They were all "family members" or "visitors".  Two claimed it was an accident despite the fact that the patient was on seizure precautions and they were on camera for the whole thing.  We also have had over 12 sharps boxes go missing.

Hour-glass sign

Technology is amazing.  Before, I would have to roam the halls of the hospital to try and find the chart of my patient.  It might be in the rack, with the ward clerk, back with the case manager or left in radiology.  I probably spent several hours a week not to mention walked miles to find those darned things.  Now, I just have to find a computer, log in and sit there for hours looking at the little hour-glass sign while the computer locks up, stalls and then blue screens itself into oblivion.  Technology is awesome, it lets me at least sit down?

White Lie Pneumonia

I know that often people will tell little white lies because they want to tell you what they think you want to hear.  We see it all the time. "Sir, do you use any street drugs or pain pills?"  "Oh, heavens no!" We run the tox screen and it is pan positive.  "Do you use alcohol?" "No." DTs on the way.  I try to get people to be honest with me and try to explain that we are asking these questions so we can better help them.  It still doesn't work.  "Sir, did you have anything to eat or drink after midnight?", "No".  The bronch after the aspiration that occured during induction for the elective surgery sucked out what appeared to be bread, egg and either sausage or ham.  Talking with the family, they all hit Hardees on the way to the hospital.  The patient thought a couple of biscuits wouldn't hurt.

Macular degeneration (cant see the disc)

We see patients from all over several states.  No matter how hard we ask, most of them forget to bring their xrays.  They will bring the report but not the actual films.  Our schedulers call them and specifically ask them to go to where they had their xrays and have them put the images on a disc and bring it with them to their appointment.  When they don't have their xrays the patients get mad because we really cant do anything until we see the films and blame us.

Curbside Contagion

One of my partners biggest pet peeve is when she is on the OR and one of the staff comes by and asks if she can look at their throat or listen to their lungs because they think they are coming down with a cold.  Of course, if they are, it is a cold and their is not much to do about it.  Secondly, you will get the cold.  Sure enough, someone came by and asked her, she tried not to but did not want to look bad.  Despite the flu shot  she got the flu.  Now she is out and so are her patients.

Negative fecal matter on the slide Dr. Sherlock

I know that you will find it amazing, but the recent Rand study (the same people who promoted EMRs) shows that Electronic medical records did not reduce medical costs nor did they improve care.

http://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html