July 16, 2010
In this week’s mortality meeting some interesting points came up. A lot of the discussion related to getting lab results. The intern presenting the mortality data said that three blood cultures had been sent but that one sample had been “lost”. Of course, one of the lab technicians took exception to that and explained that as soon as the sample is received from the ward, it is given a number and written down in book. The intern was also asked as he presented his case what the biochemistry results (blood glucose and protein) were for the blood culture ordered. His reply was that they were not done, again which the lab technician said was not possible, unless there had not been enough sample (~ 0.5ml), in which case, it would be noted down again in the lab book. It was probably a case that he had come when the white blood cell etc result were done, but not yet the biochemistry, and he had neglected to check back.
At the end of this presentation, he raised the question if whether or not there could be a lab technician overnight. The doctor who seems to oversee the lab asked him what he thought there wasn’t already a lab technician on call overnight, to which the intern said he had no clue. The answer seemed obvious, that there was a lack of funds available to pay for such a service, which is indeed the case.
After the normal mortality presentation was done, a lady gave a special presentation about proper documentation, especially when data is being collected for a study. She brought with her a few examples of forms that had been submitted that hardly had anything written on them at all. The whole presentation is in preparation for the electronic data record system that is going to be set up throughout Queen Elizabeth’s in the upcoming months. Its particularly important that lab request forms be filled out properly, otherwise the request for blood culture etc will be thrown out.
The overall theme of the whole meeting was one of how lapses in providing complete, accurate and correct documentation prevents good care from being given. One doctor pointed out that many times it is not doctors, or even medical students who are filling out forms, while another responded that even if your nurses fill out forms it is essentially the responsibility of the attending physician to be follow up and make sure forms are being filled out properly. Dr. Sarah Rylance has personally been trying to improve the morality data of Chatinkha ward by typing up all deaths, their causes and the patient information in her own computer. The problem of neat and accurate recording of patient progress and treatment seems to be a problem in all healthcare systems. For example, a study done through Weill Cornell Medical Center compared the error rates of handwritten prescriptions versus eprescriptions which are done through a computer programs which can also check for drug interactions and can supply common doses. The rate of error in handwritten Rx was 42.5 per 100 prescriptions written, while error using eprescription was 6.6 in 100. The electronic system helped alleviate simple numerical errors, poor handwriting and overlooked drug interactions.
Certainly helps reinforce the lessons we have been taught about keeping good lab notebooks and recoding everything we do for our design projects.