Death by Tube

There have been posted on the Internet serveral studies which say that nearly 10,000 persons are killed in US hospitals yearly from avoidable mistakes.  Hope it’s not true..but I’m afraid it might be!

As a student nurse, who has spent hours and hours learning the art and science of nursing, I take issue with your cartoon, Pat. You mock the dedicated, hardworking health care workers who devote themselves to their patients.

Part of a nurse’s education is learing about the cost of making a mistake. In most hospitals there is oversight, not to mention detailed protocols in place to prevent errors. Did you know that some patients fiddle around with their own IV tubes and catheters?

The tubes you mock in your cartoon save lives.

Yes, hospital errors take place. But health care administrators are dedicated to setting up systems to prevent them. The nurse is patient advocate. We are taught to assess everything about the patient. We double and triple check everything. We are taught early on how to calculate doses (and it’s tricky) because even doctors make mistakes. We are expected to know how to do algebra and arithmetic the old-fashioned way: with a paper and pencil. Why? Because if you don’t have a fundamental understanding of numbers you don’t know if a reading on a machine doesn’t make sense.

Nursing teachers always say “Look at the patient, not the machines.”

Ferd, there is plenty of supervsion in hospitals, not to mention administrative assessment plans. Many nurses burn out on the job because every time the government decides hospitals need more oversight it makes extra work for the nurses. In lots of cases the “work” is not helpful at all. As a nurse, you want to treat the patient. We are losing good nurses because of the extra paperwork created by insurance companies and the government.

And it will be worse under Obamacare.

 We are losing good nurses because of the extra paperwork created by insurance companies and the government.
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I do understand the mindless paperwork, arabella, which is part of a process that is designed to paper a bureaucrat’s backside and is not meant as a means to improve care. My comment was directed specifically to the instance of the use of a black rubber hose from a sphygmomanometer for introduction of intravenous fluids. That is criminal.

I don’t think that suggesting that different “tubes” for different proceedures be made incompatable or that using an across the board color coding system is blaming the dedicated nursing staff. They do, as all human beings make mistakes. Mostly they do not.
 
I think the problem, as usual lies with the medical suppliers who resist any improvement that might save lives if it impacts their bottom line. 
 
As well as with the governmental agencies that are tasked with protecting the citizenry but are more concerned with the bottom line of companies that support one party or another. 
 
We all know that we are going to die. But somehow dying for an “oops” that could have been prevented is adding insult to injury. JMO

at, where do you see Pat “mocking” tubes?  I don’t see any mocking in this post…only genuine concern for a documented problem.

My sister is an ER nurse.  Has been for forty years.  The tales she tells of mistakes made in the hospital would curl your hair.  Having been the victim of one incompetent ER doctor myself, I don’t have any trouble believing them.

I don’t understand the problem with color-coding.  Tanks for oxygen and other gasses all follow a standard color coding.  What’s so difficult about doing that with tubes?

Important topic and descriptive cartoon, Pat.

Those interested in checking the regulations from the FDA on reporting adverse events from medical devices may want to check the link below.
Being defensive about the many medical errors causing many deaths should wake up and smell the reality.

http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/PostmarketRequirements/ReportingAdverseEvents/default.htm

Oh, I am not so idealistic and naive as you think. I have seen many, many hospital errors as a patient and as a family member. A top ranked hospital almost killed my mother. I always ask what a health care provider is doing before they administer a med, or do anything with equipment. You can’t take too many precautions in a hospital.

However, I think Obama has a plan that will eliminate the need for tubes, medication, and medical intrumentation. Remember Mao’s “barefoot doctors”? Just get ACORN involved in sending people out to “take care of” the health needs of Americans. Think of the cost savings!

Think I’m kidding? Maybe I exaggerate a bit, but the prospect of employing undereducated “Community Health Care Workers” to check in on (spy on) families and check out what’s in the fridge would be a good first step.

And those tubes could come in handy in the case of people who cost a lot to maintain, but refuse to die and get out of the way.

Agreed that this should work, Creeper.  BUT the problem has been that different companies use different colors for the same typeof tube, making things even worse for hospital staff. 

This requires, among other things, international cooperation for a color coded standard, which is getting more difficult to come by in these hostile times.

It really helps if you can have a friend with you at the hospital. Somebody who can ask questions and help medical people focus on what they’re doing.

The vast majority of the time, there is no malicious intent, people are dedicated and caring. It’s just that human error is a fact of life. There are people working 15 hour shifts taking care of a dozen patients.

It’s not a slam on nurses at all, I have a whole family full of nurses. They have to constantly check and recheck what they’re doing to help remove the possibility of human error. That’s just life.

Agreed, Clara.  My mother underwent brain surgery for an aneurysm and had it not been for one of her 10 children being there at all hours, including sitting in the Neuro ICU waiting room the 3 hours of every 6 that only staff was allowed to tend to the patient, we might have lost her.  Nurses and nurses aides are overworked, underpaid, and IMO, the main healers in the healthcare world.  Had we not kept a watchful eye on the meds, feedings, therapy and the 3-inch thick patitent notebook we had to remind nurses to check before any shift change, we’d be at a funeral instead of guarding our mother through surgery, ICU, Acute Care, Residential Rehab and home care. 

Add that awful health scam bill that feeds Big Pharma/Big Insurance, and being a patient in any American hospital is even more dangerous.

This is very interesting since I have had a recent illness.  I also work in a hospital.  This hospital also had to place a drain in my abdomen.  Twice.  I have had terrible care.  This entire last week the Interventional Radiology Department could not get straight what they were suppose to do for me.  It wa a clusterf*ck of gargantuan proportions and I will not allow them to EVER place another drain, even if it means months of medication before I get 100% better!  What I think the problem is is the electronic medical record.  I can say so because that is my job every day (when I am not on Medical leave).  When I have to read the charts, I have to wait for all the notes to load.  It can take forever and the system does not tell you when the record has loaded completely.  The caregivers are in such a hurry that I believe they often don’t realize all notes and orders are not loaded and they cannot find what they are looking for and do not seem to know what they are doing.  If I gave all the details of this past week and what I went through and how it took an extra 4 days to get anyone to remove the drain, after it was no longer draining anything, you would be shocked at the level of not knowing and confusion that everyone had about what my care plan was.  I can’t go into it all, but I will say that the electronic medical record is the most dangerous thing to ever happen.  Paper charts are much easier to follow.  Electronic records are tedious and providers don’t have the time for it.  Also, God forbid that the computers go down, which they do.  computers are just not better than humans actually using their brains, IMHO.

Yikes csuzeq –now that’s a terrifying story.  I will have to look into the electronic record issue.  I hadn’t really considered the concerns you raise.

Do not allow any computer that stores records to be connected to the Internet.  That is elementary computer security.  The only computer that can’t be broken into is one that nobody can get to.  That makes the computer into a doorstop, but you can and must minimize the risks.  Once some hacker gains access to the records he/she (usually he) can copy them … or “amuse” himself by selectively editing a few of them.  Serious bad news.

Do not allow any computer that stores records to be connected to the Internet.  That is elementary computer security. 
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Spot on. You keep hearing about how power plants and the like are spending lot of money protecting their systems from hackers. Why spend all that money when the answer costs nothing–unhook the plant operating systems from the internet. End of problem. Internet connectivity should be limited to systems that have no vital function in a system. We spend billions on crap we don’t need for a problem that is easily resolved.

and it’s going to be sooo much better when we have Obamacare..right?

Don’t think so.

Even if you asked, they wouldn’t listen to you.  Everytime I have to have an IV inserted, they always go for the viens around the elbow in my arms.  I Always tell them not to, to put it in the hand because they always have issues with it rolling in those viens.  NEVER do they listen, and still try to go there and then after they get it in, its very uncomfortable and they say, Yeah they rolled.

OKAY!  Listen to the patient, what does it matter where it goes in.

As more men go into the nursing profession, the color coding system would not be a “catchall” for errors.  Color changelling (colorblindness) is almost 100% doninate in males.  My son and my son-in-law are both color challenged and both have electronic work – my son is a computer and telephone technician; and my son-in-law retired as a computer software engineer.  Both have compensated by learning to “read” certain colors, or ask a co-worker. 

Several years ago there was a (RN) nurse at our local hospital who changed a saline bag on a patient, but she did not check or double-check the medication in the replacement bag before connecting it to the right tube; it wa not the prescribed med and  as a result the patient died.  The hospital “settled” for $xxxx,  and the nurse lost her license.  That was carelessness on her part….and apparently there were no checks & balances, or oversight.  I don’t know how far licensed RNs, or LPNs, should be required to have another person double-check, or even write the name and perhaps a “lot” number of the med on a specific form before inseerting.  However, there will always be lapses and mistakes, no human being is perfect.

I have a granddaughter who has a BSN and works in the surgical recovery room of a major hospital.  Nursing is a very demanding job.

The programs are also very expensive and work best when you purchase all of the updates, etc., part of the sales pitch as well.  Unfortunately, the hospital I work at has had to forgo the last 4 updates because they are struggling financially.  This doesn’t help.

And no, computer records do NOT save time.  I am a medical coder and used to go from room to room reading the physician notes and was told how much free time I would have when on the computer.  That did not happen.  Now, I do not walk all over the hospital every day (and I have put on weight!), but it is very difficult to find all of the notes I need.  The filtering system you can use is no help because it will inevitably miss something.  If you set up your filter incorrectly, it will not find dictated notes, only typed in notes, and vice versa.  Some doctors are not the best typists so they dictate their notes.  Some prefer to type.  These systems are so cumbersome and NOT user friendly that it is shocking, although when you think about it, computer people set this up and know computers, but not necessarily know anything about the practice of medicine!  I would go back to paper charts in a heartbeat, but Obamacare made it illegal.  everyone must go electronic.  Think of the rural hospitals that cannot afford this!

Yes, they need to listen to the patient!  I had problems with that as well this past week.  They said they could not take MY word for what they were supposed to do (which was just remove the drain).  I had to remind them that even if I was changing the plan, which I wasn’t, I had the right to refuse medical procedures.  If you are not in a life threatening situation, and you EVER think that a care provider is planning something that is not what you understood was supposed to happen, do not be afraid to say NO, loudly and repeatedly if you have to!!  It is much better to have people stop, think and verify, rather than do anything to you that you don’t need, including medication.  If you have not been told in advance what medication they plan to give you and what it is being given for, be sure to ask. 

I have a doctor who will ask me straight up what I think is wrong and how I want to treat the problem.  He’s maybe not the brightest doc in the world but he doesn’t try to steamroller me like every other doctor I’ve known.

This thread reminds me of the time my mother was discharged from the hospital…with her IV line still in place.  Nobody noticed it under her long sleeves.  When she called after she got home, to ask if that “thingy” was still supposed to be in her arm, it took five minutes for a paramedic to show up on her doorstep to remove it.  THEY knew what kind of lawsuit they were flirting with, even if she didn’t.

It DOES happen in civilian hospitals, HEP-T.  See my post above.

“In the meantime, it probably wouldn’t hurt to ask the staffer to carefully explain those tubes before they get stuck into your innards.”

Fact is, Pat, the tubes in your ‘toon remind me very much of “innards.”  They’re glossy and slimy–and when you go into the hospital, it’s one big spaghetti swarm of interconnecting innards–tubes right into your guts and veins.  And you trust the nurses with their little beepy meters that are always beeping unanswered beeps hanging on aluminum trees to manage the vinyl plumbing that is keeping you alive and manage your pain . . . (not to mention that tube that is going up between your legs) but not to worry . . . we’ve got a new 2000+ page health bill that will straighten things out . . . And somehow it all just blurs together into one big nightmare of tubes . . .

I just want to go home before I die . . .

Major surgery, Rev. Amy?   We can’t do without you, so please inform the surgeon of that  fact . . .

When administering medication, a nurse should follow the 5 R’s (and even a couple of more have been added over the years).  Right patient, right drug, right dose, right time, right route.  This applies to IV medication as well as oral.  Standards have changed, and medication is supposed to be added by pharmacists with the bag labeled and nurses are still supposed to check the 5 R’s at the time of administration. 

arabella, you mentioned that you were going to take the GRE, so I’m guessing that your nursing degree is part of a BA (BSN?) program.  But, as I’m sure you know, a person can become an RN without a 4 year program in college.  They can go to a technical school and become an RN in much less time.  I wonder if the people in the short programs get the same rigorous program that you have had….

Cont.

I watch those TV commercials for drugs and always after the speed talking spokesperson mentions the possible side effects  I say to myself–cross that one off the list as something I’ll never take.  My favorite so far for a side effect is “asthma related death.”

But, as for electronic records—I’m all for them.  I keep mentioning that I am on Colorado’s Kaiser Permanente insurance.  ALL my records are electronic.  If I go to a specialist in a different KP office, that person sees all my history immediately.  I get emailed results almost as soon as my doctor gets them if, for instance, I have blood tested.  I can even use the KP system to make little charts for myself–say for instance if I want to see how the glucose reading changed or didn’t over all the blood tests I’ve taken in the system.  Because of the system, all my doctors in the hospital provided my regular physician all the information immediately.  When I broke a finger last summer and had an X-ray taken, I went from the trauma clinic to the x-ray lab in the same building and then walked back to the clinic to see my results and was out in less than an hour, with an appointment with a hand speicalist in the speicalist building a 20 minute drive away, where that specialist could immediately access my original x-ray.

My son’s girlfriend recently was diagnosed with an ovarian cyst under her insurance system.  From the time she had the original diagnosis and the referrals to specialists who wanted new tests at a different facility, which requred that she wait for those text results to be mailed to the specialist, who then needed another test–etc., etc., etc.–it took her about three weeks to really know what she was dealing with.  Now all her records are scattered and kept in various offices–no one can easily access all the information on her.

This was the first time since 1999 that I’ve been to a hospital (after I slipped and broke my thigh on a hotel parking lot that had a dust of snow covering it (couldn’t see the ice beneath).  I felt safe at that hospital also, but maybe I was lucky.  I was in a different insurance program at the time, so I know that if I ever need to access those records, I will have a heck of a time finding them and getting them.  That is why I feel I will stay with KP until I die. 

When my mother died on the operating table–long story–it became clear that if the cardiologist had access at the time to all her records he would not have recommended the procedure he did.  She had been to so many doctors during her life.  She died at 58, and after her autopsy we FIRST learned of the fact that she had a birth defect that caused the problem on the table and that had been the root of many of her health problems.  But each of her doctors had started “cold,” so to speak and had never been with her long enough to figure it out.  Lifelong electronic records would have been such a good thing for her to have.

Electronic medical records certainly have the drawbacks many of you mention.  However, a bigger problem is that hardly anybody can read the scribbles of many doctors and other staff.  I worked for years in a hospital setting with access to and writing in medical records and  progress notes.  A lot of errors come from inability to read the writing of hospital employees who write in the records, many using shorthand and abbreviations unfamiliar to others.  There is a lot of guess work and often it is impossible to find the person whose records you can’t read in order to check on what you think they wrote.  Sometimes the doctors can’t read their own writing.

Surgery Rev Amy? How soon is soon? Dang, keep us informed(not being nosy, just concerned). We do need you, and love you too. I sure don’t like hearing this.

Sorry late to the article, Thank You Pat, it is an important look into something we can easily overlook. Excluding children,the other part of the problem can be not being with a family, say a person who has no one local, to look out for them, as well as the patients who may not seem interested in what is happening to their body. Patient honesty, responsibility and feedback is incredibly important in providing good care. IMHO. I am vigilant with my records, and every bit of my treatment, but I am also a former Nursing Student in a BSN program, with quite a few clinicals and employment in the medical field under my belt, I know what to watch out for. I found most errors are just mistakes, but sometimes there are people who have no business being in the medical field, just like any other job. If you do not like your care, or are having a reaction which seems not “right”, speak up, and insist. As was mentioned upthread, switiching providers, or hospitals, or Physicians is recommended when the care is lacking. Also I wonder what the influx of third world students into the American Medical system, has done to the level of care. Our standards are different and I have seen first hand, poor treatment by nurses who came from third world countries. 

I volunteered in a hospital for several months and I pray I never have to go to one as a patient ever.  I am sorry, but those places are scary. 

For one thing, yes, if you have someone who can stay with you 24 hours a day you have a better chance of survival than someone who is there alone with no one to represent them and care for them. 

Also, if the nurses don’t like you, you don’t get as good as care. I guess that is only human but it is not reassuring.  I witnessed one poor man who was finally rescued by a CNA with a heart….she must have been an angel.  All the nurses did was complain about how he was making problems for them and hard to deal with.  The man was unable to communicate, I don’t know, he might have had a stroke.  They had a catheter up his urethea and no one had bothered to check it for quite some time and that was the problem.  He was completely backed up.  Thank god for this CNA, who had just figured it out, cleaned him up, and he was sitting  peaceably and calmly in a chair next to his bed. 

I pray I stay healthy until the day I drop dead.

I already have a degree in Biology, but it’s “old” so have had to take some prerequisites for a BSN (Bachelors in Nursing) again. I am applying for a ”Combined Degree Program.” This is a two year course of study that grants a BSN and MSN in nursing. A graduate of such a program is qualified to be a Nurse Practioner. I am only applying to two Universities, and the admission process is extremely competitive. (Hence the need for the GRE – it’s a graduate program.)

The training I’ve had so far has been extemely rigorous. If I want to practice as a nurse or a nurse practioner in New York State I need the degree(s). Supposedly, RN’s are being given a four year grace period to get a BSN. Now a days, patients in the hospital are “sicker” than they were 20 years ago. Lots of procedures that used to require days of hospitalization are now handled as out patient procedures. (Thanks in part to laproscopic surgery.)

I have seen many, far too many instances of health care aides, CNA’s etc. taking short cuts, failing to observe important patient changes and doing things wrong. It is crucial to have well trained staff. The problem is, education  is expensive and many jobs that require a lot of hard work pay very little.

I admire and envy the older nurse who learned the “old school way” where they were focused on patient care. They did not require college degrees. These older nurses are absolute treasures. They think these young nurses with BSN’s think their shit doesn’t stink. Sorry to say, they are right.

I am filling out my applications, but undergoing a crisis of conscience. Am I doing the right thing? I want to help people, alleviate suffering and comfort familiies. Ironically, I could do more of this kind of thing as a CNA. But I can’t afford to be a CNA. An experienced CNA makes $20.00 and hour.

I pray for guidance. I hope I am making the right choices. My teachers all tell me I will be wonderful nurse, and that I have special talents that the world needs. I don’t see that myself. Lately I’m just depressed about it. But hopefully in the end I will wind up on the right path.