Slow day to day. Feeling a lot better but also itching. I reported this earlier to the night nurse and she thought it might be a side-effect of the dilaudid that I took earlier for a headache (gave me mild hallucinations which music cures.) Took some time to read over the drug fact sheets and what they do and what side effects to look out for. It turns out that the itchiness is a possible side effect of the G-CSF. The day nurse stopped by and will report it to Dr. C.
The whole topic of system safety in medicine is, of course, very interesting to me as a devotee of James Reason and my work with FAA Flight Standards. There are clearly zillions of procedures for doing things, from the simplest procedures of the porters calling for elevators and doing pick-up; thru the slightly more complicated procedure of taking vital signs; up to the ordering and dispensation of drugs. Many of these procedures require placarding, i.e., instructions in English that must be followed, including the matching of the patient ID tag before executing them. This particular one is an easy one to omit. Other procedures, it appears, could be executed incorrectly, such as the taking of vital signs; obviously those executing those procedures need to be trained. Patients and visitors must also follow procedures and are less easy to train.
The role of the hospital administrator does not appear to cover the design and establishment of procedures, or the internal overview of them, so I wonder who does it? Who, in the hospital, has the system overview for safety?
Obviously the patient himself has a role here, to educate himself on what looks right and wrong. That thought, actually, was what prompted me to read over the drug fact sheets earlier today.
Some of the hazards are mitigated by physical design. For how the tubes connect and for the color-coding of the various blood vials. But here again this opens the door to human error. One of my daily blood samples has to be in a tube with a light green top, but when I asked the nurse what would happen if you developed poor color vision she didn’t know. “I suppose you can’t be color blind.” There’s obviously a lot of safety designed into the more sophisticated items, such as the pumps and the Alaris computer that delivers the drugs and saline solutions through my porta-cath. Even less sophisticated items have safety designed in, such as the pole with its 5 wheels that is probably – haven’t tried it – almost impossible to topple over.
Another thing I have not figured out yet is, who is responsible for oversight of the safety procedures? What are the roles of the hospital, the state, and the federal government in this regard?