The University of California-San Francisco (UCSF) has made a significant announcement that could be a watershed moment for how medications are given to hospital patients in the United States.
In a typical hospital setting, patients are receiving many different types of prescription medications — ranging from mundane vitamins to more intense drugs such as chemotherapy. In the thousands of times medications are given to patients, and with the high number of humans handling the process of organizing and giving the medications, human error is bound to occur. And medication errors can be life threatening — especially if related to a chemotherapy agent.
UCSF wants to make the rate of error for medication administration to be zero. In order to do this, they are using robot technology to prepare and track medications, with the main goal, obviously, being to improve patient safety. In the phase-in of the project, not a single error occurred in the 350,000 doses of medication prepared — remarkable.
Once computers at the new pharmacy electronically receive medication orders from UCSF physicians and pharmacists, the robotics pick, package, and dispense individual doses of pills. Machines assemble doses onto a thin plastic ring that contains all the medications for a patient for a 12-hour period, which is bar-coded.
There are some key advantages this system brings to the workflow of a hospital setting:
— The robots can do chemotherapy dosing, one of the toughest and most sensitive things to do. They can also do complex IV medication dosing.
— There is no touching of the medications by hand. The medications come from the manufacturer, are processed by the robots, and then sent to the nurses and the patient’s bedside in sterile packaging.
— The robots allow for pharmacists and nurses to be more efficient by taking away repetitive tasks. While they do not replace either, they enable a healthcare system already stretched for resources to increase productivity.
— The system costs $15 million, but with the payoff in regards to improved patient outcomes, as well as time saved, the investment should make this endeavor by UCSF more than worthwhile.
I am a doctor. Go ahead, call me what you may. Group me into a neatly, prejudged category: “All you doctors.” Just don’t label me a sponge.
That’s right. Recently in the Wall Street Journal, Mr. Andy Kessler, famous author and former hedge fund manager smart enough to turn $100 million into $1 billion, grouped doctors into a sub-category of the service economy which he labeled as “sponges.” We could have done worse: His other categories included “sloppers” (DMV workers), “slimers” (financial planners), and “thieves” (cable companies).
It seems that doctors — along with cosmetologists, lawyers, and real estate brokers — offend him because of the tests and licenses that we deem necessary:
Sponges are those who earned their jobs by passing a test meant to limit supply. According to this newspaper, 23% of U.S. workers now need a state license. The Series 7 exam is required for stock brokers. Cosmetologists, real estate brokers, doctors and lawyers all need government certification. All this does is legally bar others from doing the same job, so existing workers can charge more and sponge off the rest of us.
His essay goes on to argue the tired notion that technology endangers jobs in the service sector — the toll booth operator argument, again. He likes the creators of stuff: Apple and Google. (Duh.) But in my mind, doctoring is about creating something: We create better and longer lives for our patients. Ask the patient cured of cancer how happy they are that some doctor created his or her treatment plan. Read more »
*This blog post was originally published at Dr John M*
Whistleblower readers know of my criticisms of the electronic medical record (EMR) juggernaut that is oozing over the medical landscape. Ultimately, this technology will make medical care better and easier to practice. All systems will be integrated, so that a physician will have instant access to his patients’ medical data from other physicians’ offices, emergency rooms and hospitals.
In addition, data input in the physician’s office will use reliable voice activated technology, so that some antiquated physician behaviors, such as eye contact, can still occur. Clearly, EMR is in transition. I place it on the 40 yard line, a long way from a touch down or field goal position.
A colleague related a distressing meeting he had at the community hospital he works at. This hospital, like nearly every hospital in Cleveland, is owned by one of the two towering medical behemoths. I’m not a businessman, but I have learned that when something owns you, it’s generally better for the owner than the ownee. This meeting was about the hospital’s upcoming EMR policy. Sometimes, these hospital meetings are ostensibly to seek physician input, but the true purpose is to inform the medical staff about decisions that have already been made.
In the coming months, this hospital will adopt a computerized ordering system for all patients. In theory, this would be a welcome advance. It would create a digital and permanent record of all physician orders that could be accessed by all medical personnel involved in the patients’ care. It would solve the perennial problem of inscrutable physician handwriting, including mine. Read more »
The puppeteer skit features the interaction between a young man with a rash and his older physician. The patient is an informed kind of guy: He’s checked his own medical record on the doctor’s website, read up on rashes in the Boston Globe, checked pix on WebMD, seen an episode of “Gray’s Anatomy” about a rash and, most inventively, checked iDiagnose, a hypothetical app (I hope) that led him to the conclusion that he might have epidermal necrosis.
“Not to worry,” the patient informs Dr. Matthews, who meanwhile has been trying to examine him (“Say aaahhh” and more): He’s eligible for an experimental protocol. After some back-and-forth in which the doctor — who’s been quite courteous until this point, calling the patient “Mr. Horcher,” for example, and not admonishing the patient who’s got so many ideas of his own — the doctor says that the patient may be exacerbating the condition by scratching it, and questions the wisdom of taking an experimental treatment for a rash. Read more »
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