This is a continuation of yesterday's post.
Part of anesthesia is anticipating emergencies and treating them timely. Clinical situations in the operating room can arise so quickly that we have to be ready to act at any time. Thus, for every case, I draw some "emergency drugs," mostly to control blood pressure. But if at the end of the day I have emergency medications I didn't use, I have to throw them out. I'm not sure how to reconcile this problem. Emergency vasopressors such as ephedrine or phenylephrine can take a minute or two to dilute and prepare, and in a critical situation, this time and distraction can lead to patient harm. After medications expire, they should be discarded. There's no way around this; in order to keep my patients safe, I have to draw medications I'm not sure I'll use. What happens to vials that are drawn but not used (or vials that are broken)? I assume the hospital simply absorbs the cost, and that too, is another reason why hospital finances can be so tricky.
It's not just a problem with drugs. In the same way, prior to intubating a patient, I have two different laryngoscope blades available, one as a rescue blade if I run into trouble. I always have both available, but rarely have to resort to the backup. I used to take out two oral airways until we had a shortage; now I am a lot more conscientious of producing unnecessary waste. I used to have two sizes of endotracheal tubes available, but now I think of each patient to decide whether I need to have multiple prepared. These are all instances where I prepare more than the minimum equipment, thus using resources and my time. But a lot of these, at least in this stage of my training, seem to be necessary to ensure patient safety.
All I can do is to be aware of how much I use and how much I waste, and within the confines of what is safe for the patient, minimize anything unnecessary.
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In ancient Greece, the asclepion was a healing temple dedicated to Asclepius, the God of Medicine. Asclepius learned the art of surgery from the centaur Chiron and had the ability to raise the dead. The Rod of Asclepius is a roughhewn branch entwined with a single serpent.
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Hi! I am Craig Chen, a third year resident physician in anesthesiology at Stanford Hospitals and Clinics. I went to medical school at the University of California, San Francisco. Prior to medical school, I studied philosophy and biology at Stanford University, along with a minor in creative writing.
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4 comments:
What do you think about a potential technological fix, like a machine that's a cross between an infusion pump and a vending machine?
I could see the advantages: less waste, less wasted time. What are the disadvantages?
Oh, that's a fascinating idea. I imagine rolling a patient back to the operating room and connecting the IV to an infusion "vending machine." With a touch of a button or a voice command, I can ask the pump to deliver pre-stocked medications. It dispenses the medication in a sterile fashion, pushes the exact amount of carrier fluid to get it into the patient, and records the dose.
That would actually be quite an engineering feat. And it seems like it could be a brilliant aid. Concerns would mostly be about how failsafe it was; could it dispense the wrong medication? What if drugs needed to be given in an emergency, would the machine hold everything up? But of course, these are silly questions if the engineers build it correctly. We know that medication errors are more common with humans and most technologies allow the user to override things in extenuating circumstances. I do occasionally like pushing medications myself because there is a tactile feel of how the IV runs.
I would really like this invention. The act of preparing and delivering medications is a menial yet daily and important task for the anesthesiologist, and replacing it with technology could relieve us to pay more attention to the patient.
UCSF already has a robotic pill dispenser:
http://www.ucsf.edu/news/2011/03/9510/new-ucsf-robotic-pharmacy-aims-improve-patient-safety
Admittedly, liquids would be harder than pills to keep track of. Pills can be sorted in discrete numbers, and they can be carried in tiny plastic bags that have barcodes.
But I imagine that anesthesia would have to be headed this direction. Already, there are those pain buttons that allow patients with epidurals to get a dose of their medication--a sort of user-controlled sterile drug administration. It's not much of a leap to imagine a second drug, then a third, and so on, being dispensed from a machine that used to dispense one.
I'm sure a techie on the Stanford campus would love to tackle an idea like this.
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