Tuesday, February 27, 2007

Stuck in the Middle




Seem to be in a pattern here: post about something bad in the OR, then something cool. Here's another bad thing, based on a bad thing. Then maybe I'll get off it for a while.

Getting stuck with a needle has never been fun, even before it could be fatal. I've had my share. Converted my hepatitis titer while I was in San Francisco, though I never got sick. If nothing else, sometimes it hurts like hell, right in the middle of a case. Methods to prevent getting nailed are in the category of the desirable. Great minds attend to it. Less than great minds appear to be the ones, so far, to have come up with solutions:






And I couldn't even find a picture of the worst offender: probably got sold just before the sales force slunk out of town. The "safety" part looks like the back leg of a grasshopper, as it slides up and down the needle. Where I work, the hospital bought it by the pantload.

Anyhow, the point is this: laudable as the concept might be, the "safety needles" I've seen and used to date are anything but. Cumbersome, clumsy, and complicated to use, they interfere with the underlying purpose; namely, to inject stuff. Trying to fill up the muscle with local anesthetic through a small incision is all but impossible. So, at least in the operations I'm involved in now, we cut the damn sleeves off, defeating the entire purpose. The good news is that in doing so, we are actually making the procedure safer. The hospital recently completed a study: since the advent of the particular needle used in these parts, needle sticks in operating room personnel have gone UP!!!! Is anyone surprised?

Work-flow. Ergonomics. Energy expenditure: not my bag except in figuring out how to do what I do. But my two-cents worth says: the more complicated the system aimed at simplifying things, the more opposite from effective it is. The more people have to manipulate things in order to make their manipulations safer, the unsafer they get. Paying attention is really all it takes. However: I already admitted to my share of pokes. So, whaddya gonna do? Screwed. Either way.

5 comments:

beajerry said...

The only needle sticks I've received have been during vial draws,and it's because of the slipping protection sheaths making things cumbersome to get the needle cap back on.

Anonymous said...

Many OSHA requirements are similarly unworkable. For instance, you aren't allowed to work on the top level of a scaffold unless it has rails, but if there are rails then working with long materials becomes cumbersome. Therefore the workers themselves are often on their guard against OSHA.

Heavy construction and farming equipment is notorious for having built-in, onerous safety restrictions. Typically the owner loses patience at some point and disables them.

My Sears riding lawn mower will stall in reverse unless you put the key in a special position. No doubt everyone does this, so the only purpose it serves is in court: the plaintiff knowingly put the key in the reverse-enabled position, therefor he acknowledged the danger of driving in reverse.

Scaffolding has stickers on it indicating that it should not be used on a slope!

On the other hand, many regulation are apt and sensible, such as the one requiring that children's furniture and deck rails have gaps too small to imprison little heads.

It's no doubt a complicated balance, but when common sense loses out there definitely a net loss.

Patti said...

It was much easier to insert IVs until my hospital converted to a safety IV catheter system. Which meant the patient ended up getting stuck more times. When the OR converted to safety hypos, they were so cumbersome that most of our surgeons asked for the safety device to be broken off. I agree that they make it worse- it's better to use the standard equipment and pay attention.

DK said...

As a student nurse I pay close attention to everything everyone in the hospital does. Since I have no experience in the non-safety needle world, the safety needles don't bother me (maybe they will later on). However, It's funny to see how few experienced people will engage the safety on the darn things.

Personally I like the lovenox prefilled syringe safety mechanism.

faded said...

Simplicity is king.

I write software for a living. The interface on my web based software is very simple. All the commands to do any activty are arranged in a column on the left side of the screen. To see them just scroll up and down. My customers love it. They can find what they need. It cuts training time by 60%.

Software interface designers hate the interface on my software. They say things like, it's boring, it's complicated (huh?). Please follow the illogic here. They say it has no structure. Since there is no structure the user cannot be lead thru a series of steps to prevent the user from making a bad decision. The addition of this "structure" ,much like a needle cover, confuses users and increases errors.

The interface on the software does give the users a chance to make mistakes and bad decisions. But I believe users are smart and know thier jobs better than I do. Guess what, the users make very few mistakes after they are trained and understand the software.

Simplicity is king.