Saturday, November 15, 2008

Am I a Luddite

Technology was supposed to make life simpler for us. In some ways it has. I would never want to go back to submitting my billing on paper; paying my dues on-line is easier and of course if I wasn't writing this stupid blog, I would actually feel obliged to do some work.

A couple of new technological hurdles are making me wonder however.

At a recent staff meeting, a member raised a concern about our new anaesthetic machines. Apparently in our case room we have the newest generation Drager machine. It is in the case room because for some reason Ob-Gyn "paid" for it. The problem with this machine is that if it is turned off, it takes literally 30 minutes for the software to boot up.

So don't turn it off you say.

Unfortunately for infection control reasons all operating rooms are terminally cleaned once a day which means moving all the equipment into the hall. This means unplugging the anaesthetic machine which unlike my laptop, doesn't have a back-up battery. (My laptop also plays music and surfs the internet unlike my anaesthetic machine.) Therefore unless somebody turns it back on, when you show up at 0300 for the prolapsed cord, the machine will not work. Now there is a process where you can "hot boot", the machine however the manufacturer warns that after 10 hot boots, the software will be damaged.

Our department has exclusively Drager machines in the main OR which also have a boot up process after being unplugged but it is possible be randomly pushing at buttons to bypass this.

Does all this software make anaesthesia safer. No.

Gather round children while Grandpa tells you about anaesthesia in the olden days.

We had machines that were essentially copper pipes with valves. They were driven by the compressed gas from the central supply or from the O2 cylinder. And they were safe. If the compressed O2 failed, the N20 which was held open by the gas pressure also shut off, and a loud whistle sounded. There was a mechanical link which automatically reduced the N2O when the O2 flow was reduced and in addition it was impossible (on most machines) to completely turn the O2 off. You didn't need to plug them in to an electrical socket which meant you could if you were stupid enough or where forced to, move them with the patient to another room using the O2 cylinders. Oh yeah the O2 also drove the ventillator.

Now the greatest advance in patient safety in my lifetime was the invention and adoption of pulse oximetry. Not newer more elaborate machines that need to the plugged in to the wall socket and have finicky software. Not to mention those annoying alarms. Talk about crying wolf.

A year or so ago I went down to Ecuador. While there I went over to another hospital to do a case. In the room we were given I encountered an old Ohio machine. Some people would have fled the room in horror but I had actually used a similar machine, I was able to inspect it quickly, ascertain that it was in working order (and I am not very good with machines) and I knew that with a pulse oximeter, I would be able to give a very safe anaesthetic. Later that evening I recounted my adventure to a slightly younger anaesthetist who recoiled in horror at using a machine that in his words should be in a museum.

The second issue was the new Smart Pumps our hospital now has.

These are computerized infusion pumps designed to prevent medication errors. During the early fall nurses had to attend inservices lasting several hours to learn to use these machines. As anaesthesiologists we alone amongst physicians have to adjust these pumps we tried to get an inservice. I spent a great deal of time with the company explaining why we needed a full inservice (instead of just looking at them between cases which was what they offered). As it turned out I had to miss the inservice so I still in the dark about how to adjust these pumps. Again do these expensive and time consuming pumps improve patient safety.

No.

Will still there be medication errors?

Yes.

This reminds me that my wife who recently recertified as a nurse actually had to learn how to calculate flow rates by counting drips. She asked my about this. I told her it showed just how long it had been since most academic nurses had actually been in a hospital because nobody does that anymore.

1 comment:

Jauman said...

One area often overlooked in the battle against the transfer of dangerous infectious diseases in medical environments are the ubiquitous keyboards and mice. Standard keyboards and mice can not be disinfected because germs collect around and in seams and under keys. Recently Man & Machine, Inc. released a White Paper titled, “Minimizing Transmission of Infectious Disease in Heath Care Environments by Use of Disinfectable PC Keyboards and Mice.” It can be viewed at: http://www.man-machine.com/whitepaper.htm