Stepwise Success : Safety

Plan, Don't Panic

Scott Warner — Wed, 28 Oct 2009 10:27:00 GMT

The other week I watched a show on the Discovery channel in disbelief. Called Pig Bomb , it described hoards of feral pigs roaming the Southeast. Locals may have cross-bred the American boar with its ill-tempered cousin, the Eurasian wild boar, for hunting...(read more)

Misfiling

Scott Warner — Fri, 28 Aug 2009 10:06:00 GMT

If your lab uses a card file to track patient blood bank history, some cards are misfiled. Depending on where in the file they are placed, they may be good as gone. A blood banker won't be able to compare blood types or know that the patient has a positive...(read more)

Safe Choices

Scott Warner — Wed, 08 Jul 2009 09:58:00 GMT

The other day at a meeting about patient identification the subject of redrawing an improperly identified patient for the blood bank came up. One person thought this a terrible idea and said, "This is all about saving the patient a stick." "Actually,"...(read more)

A Thousand Words

Scott Warner — Mon, 18 May 2009 10:21:00 GMT

Incident reports are commonplace in healthcare, meant to record the facts. But do they? I've written about write-ups, including their presentation as conclusions and use as political bats. If you've worked in healthcare any length of time, you're well...(read more)

The Speed of Information

Scott Warner — Mon, 12 May 2008 18:02:00 GMT

My old boss used to say, "Any delay is too long." He was talking about programming iterate functions on a computer, but it's true for many things. We all hate to wait.

But what are we waiting for?

In a healthcare system, the speed of information is crucial to patient care. Patient identification, physician orders, and laboratory test data are moving at speeds unheard of a generation ago. Barcode scanners, bidirectional interfaces, physician order entry, expert systems and autoverification are all designed to increase speed.

But ever-decreasing turnaround time makes acceleration the goal instead of always putting information in the hands of the physician in time to make a treatment decision. It's something many bench techs instinctively know: faster doesn't always make a difference to the patient.

The key to "speed" may be meeting expectations every time, suggesting that consistency defines expectations and paces performance. We understand this in the laboratory. A phlebotomy station is easier to staff if patient flow has fewer peaks and lulls. Multiple instruments are easier to load and result if turnaround times are reliable. And any manual process works more smoothly with fewer interruptions. Less variation is easier to work around.

According to this in Clinical Lab Products, many laboratories are adopting a "real-time" performance model without priority distinction. At one hospital this reduced Stat orders from 54 percent to 3 percent. This non-traditional approach to curbing Stat abuse works by improving turnaround times on all testing. More to the point, turnaround times are closer to each other if "batch and rack" testing is eliminated.

We should strive to control the speed of information. If we can do that, maybe everyone will wait a little less.

Fire Plans

Scott Warner — Tue, 11 Mar 2008 15:30:00 GMT

The Hindu reports a fire at Railway Hospital in Perambur, the fourth largest city in India, that began from a spark generated by a window air conditioner. There were no casualties, although the laboratory runs parallel to the hospital's children's wing. And at Royal Marsden Hospital in London, a fire in a research laboratory spread to engulf a large section of the hospital as reported here. Only one patient and two firefighters suffered smoke inhalation.

These are recent, not isolated, cases. Fire is always a danger, and hospital laboratories have specific hazards that put you and other employees at risk. These include flammable chemicals, compressed gases, and combustible materials. On-call staffing policies can increase the risk of a fire going undetected. Crowded equipment can create a setting with unseen crushed or frayed electrical wiring that is a serious risk.

OSHA requires employees receive annual fire extinguisher training--a good idea--and all employees should understand fire science and prevention. Paradoxically, fire extinguishers are not designed to put out fires--large ones, anyway--but are for rescue and evacuation. That's why they are located near exits and in egress corridors. A fire extinguisher could just save your life.

Not only should laboratory employees understand fire extinguishers, but there also needs to be an evacuation plan. It's not uncommon for laboratories to have rooms tucked away beyond main corridors. You may not be able to hear overhead pages in all areas. What happens if there is a fire? How do you account for everybody in your laboratory, and how do you keep them safe?

Drills are key to reinforce training. Make sure laboratory employees know the location of extinguishers, how they are used, and what happens when there is a fire. Your maintenance/safety department or local fire department can help.