Dear Ethix – Issue 52

The automation on the nurse-patient part of the med administration still doesn’t solve the problem if the doctor ordered Zantac, but meant to order Zyrtec. The scanner tells me I’m OK, but that’s because it can’t read the doctor’s mind!

In nursing school, though, it is stressed MANY times that we follow the “5 Rights” of med administration because if anything goes wrong for the patient, the nurse could be sued too. It’s no longer a valid argument that we were just following the doctor’s orders. The 5 rights are: Do we have the right patient, right drug, right dose, right route, right time? And “right drug” includes that the drug is what the doctor ordered, and that it makes sense for the patient’s condition.

We have, as do most hospitals, drawers for each patient for their oral medications, which are refilled daily. Technology catches the error of picking the wrong pill out of the drawer. As long as I’m in the right drawer, the worst that would happen if I grabbed the wrong pill by mistake is that the patient would get it earlier in the day than ordered. Most errors really seem to happen when people are rushed and don’t have/take time to think about what they’re doing. If technology can help us catch those minor errors and buy us more time to think about why the patient is on these meds, that’s great.

We are on a computerized system for doctor’s orders, which is great for two main reasons: (1) Several people from different disciplines can all look at the chart at the same time from several locations, and (2) you can read everyone’s handwriting. BUT the major drawback is that being a teaching hospital, we are always getting new residents who are learning the system. They seem to spend a lot of time back in their Resident Room in front of the computers, and less time actually communicating with the nurses about their priorities for the patient. They don’t always realize that putting in the order is not the same as letting us know what they’re thinking. Mostly it happens when the residents order several things at once (blood draws, lab tests, medications) and there’s no way to assign priorities to these orders. I don’t always know which is more pressing. Occasionally they’ll leave orders active in the computer when I’ve been told me they are no longer needed, or the other way around. It seems like we get either communication OR use of technology and haven’t yet mastered both.

Incidentally, I have heard that there is a huge correlation between how fast the new residents learn the computer system and how old their seniors/attendings are. We’ve been computerized for three years now and there are some departments that can’t enter orders to save their (or their patients’) lives. It seems they think it will just go away. Is this one of the “details” of implementing technology that managements sometimes don’t want to be bothered with?!

Amy Girguis
Los Angeles, Calif.

We are being driven toward productivity measures with promises of bonuses. But the therapist, with one assistant, is seeing up to 30 patients per day and 100 per week while typing all the initial evaluations, progress notes, and other documentation. We also take care of the laundry and other things in the clinic. We need more than technology in our health care environment.

A physical therapist (name withheld by request)
Saint Peters, Mo.

Thanks for the Nov/Dec edition of Ethix. The pictures are colorful, clean, raw, and revealing. They naturally draw my heart to all you wrote.

I am overwhelmed and touched by the insightful and thorough work you did. I commend your courage; dedication and rough head for getting to the local people to have a firsthand experience of what life is like with them. You broke a line that most visitors don’t. We live in a society that lets the visitor see what they want them to see and hides the pains. The visitors go back to their country and believe all is well, the economy and developmental projects are on course. Ten years later, no improvement on the lives of the people, and all you get are abandoned projects everywhere.

Furthermore, my heart bleeds each time I see and hear the woes of the poor in Africa. My work in rural communities exposes me to core issues like the ones you met at C.A.R. (Central African Republic). There are riches at the center but no political will to harness them for the benefit of all and for posterity. Why is there so much poverty in Africa? But I would like to ask, why is there so much wealth in Africa and their leaders don’t want the citizens to benefit from it?

With the amount of wealth and resources in countries like Nigeria, no individual citizen has any business being poor. In the face of abject poverty, integrity is just a word. Most African leaders go to school to learn grammar but lack the ability to build practical and simple businesses that can create jobs and liberate the populace from poverty. Good program, poor implementation. Look at those precious children and young people you met, having no hope of a better tomorrow. If they eventually rise to power, they won’t do better than their past leaders because they never know anything better.

Lastly, this great edition will always be by my bedside and in my heart. I see myself there, I share in their pains and wish for a change, and it will come, in not too long a time, I believe. Also it opened my mind to some new business sense and opportunity. Great work. Keep it up.

Mark Anthony Ibekwe
Lagos, Nigeria