I had a run on patients with abdominal pain last night. The index finger on my right hand was developing fatigue from all the rectal exams. When I tried to find Hemoccult developer in the drawers where it is usually kept, it was all gone. Went in to the room next door, no developer in that drawer, either. What’s going on here?
Earlier in the day, the hospital administration removed all Hemoccult developer from patient rooms after JCAHO issued some dictum that Hemoccult developer should not be in patient rooms because “someone might drink it.” Of course that determination presupposes that no patient in the emergency department has a mental development more than an 8 month old child, but, technically, yes, removing a bottle of Hemoccult developer from easy patient access may make the emergency department environment just a tiny bit safer. Have there been any reports of Hemoccult developer poisoning lately? I called our poison control center and they hadn’t heard of any. But I digress.
JCAHO, like so many other similar programs, started with a good idea and then ruined itself by trying to be something it isn’t (and shouldn’t be). Safety is one thing. But this nit-picking micromanagement is becoming uber-micromanagement and is ruining the practice of medicine.
But I do have a concern with improving safety in the emergency department. For that reason, I have created a list of other items that should probably be removed to make hospitals a safer environment:
- If patients might drink the developer, they may eat the Surgilube, so get that out of the rooms, too. Who knows what would happen, but it couldn’t be very safe.
- Gauze sponges could be ingested and cause an intestinal blockage. Gone.
- Patients might turn on the cardioverter, could put the paddles on their own chest and shock themselves into asystole. Even if they can’t figure out how to turn it on, they could grab the wires to the paddles and swing the paddles around over their head like a modern-day Hopalong Cassidy, klonking an unsuspecting staff member who walks into the room. Store those things under lock and key in the basement where no one can get hurt.
- People might eat soap, too. Even worse, soap could be dripped on the floor and cause a slipping hazard. Get all of the soap out of patient rooms unless it has been certified as “non-toxic” AND “non-slip” by JCAHO.
- Pillows could smother someone if they are held over the face and direct pressure is applied, so all pillows must be removed.
- Sheets and blankets could be tied into a noose and wrapped around someone’s neck, so having sheets and blankets in the rooms is a hazard, as well.
- And beds are a falling hazard. We can’t keep the railings up because we can’t “restrain” patients’ movement, but if we did, patients could climb over the railings, fall on the floor, and break their necks. In addition, patients could slip on the soap they spray on the floor, fall and hit their head on the edge of a bed, sustaining a laceration for which CMS will not reimburse hospitals. Therefore beds are a dangerous item and should be removed from patient rooms as soon as possible.
- Actually, water could be ingested in such quantities that it causes hyponatremia and brain herniation (this just reminded me of an amusing story – future post in the making). It could also be sprayed in the eyes of hospital staff, temporarily blinding them, causing them not to see soap on the floor, slip, and fall and hit their head on the beds. Remove all sinks and faucets from patient rooms IMMEDIATELY!
- Oh, and when patients register, they might be tempted to poke their eyes out with pens or give themselves paper cuts over their radial arteries with the admission papers they have to sign, so we really have to keep pens and paper away from patients at any point during their hospitalization.
Based on the the thoughtful and insightful considerations from our benefactor JCAHO, I have come up with a rendering of what the ED patient room of the future will look like:
No bed. No drawers. No sink. No nothing. Of course, this rendering should probably have rubber floors and walls because healthcare workers might get injured banging their heads on walls and floors dealing with all the micromanagement. But wait, could rubber cause an allergic reaction in some patients? Maybe everything could be coated in thick layers of impact-absorbing cotton. But what if patients haven’t cut their fingernails and use their talons to dig the cotton out of the walls…? Is this safe?
Maybe I’ll just end it all and drink some Hemoccult developer.