Wednesday, May 19, 2010

The Pursuit of Perfection?

My friend has a small but wonderful garden.  It has been the object of interest and devotion of she and her retired husband.  The photo above is the beginning of what will become, some time later this summer, a tasty pear.  The tree is stretched out along the side of the house.  Last year, my friend 'severely' cut the tree back.  Actually her husband, a gentle and kind man, said she "hacked it down".  To both their surprise this Spring the tree was covered in blossoms and now those dozens of blossom are  small fruits that will mature to  produce a bounty of  delicious treats  in just a few months time.  Perhaps if one is  to be caught up in the pursuit of perfection is not the garden the place to put one's energy?  Working there is the place where we mere mortals can reach for the Divine and do little harm.

For many decades I have been a member of various quality assurance committees.  Every now and then someone will state that the quality 'bench mark" should be 100% for some care item or other.  I inwardly groan.  100%?  I am so often pleased if the health care system with all its participant  people simply "do no harm".  I do not believe 100% accuracy ( a form of "perfection") is maintainable....just ask Toyota.

This week, on two different days, two different staff nurses each gave insulin  to a patient who had not eaten two meals prior receiving the drug.  Fortunately no harm came to him because his wife was observant and as some of the nurses said "pushy" because she recognized hypoglycemia and demanded to know if her husband had  eaten his meals.  In this case, I applaud "pushy".   I am now working with nurses to help them remember what they should have remembered from nursing school...regular insulin is fast acting with a rapid onset and peaks within one to two hours of administration.  Is it searching for perfection to expect a clinician to  remember basic facts?  I put an insulin information chart in the med administration book along with the signs and symptoms of high and low blood sugar.  There is a mandatory test on the subject of insulin in June.  When the public  will pay for a nursing home nurses to carry a patient assignment of say 6 to 10 people instead of 27 to 30 and every nurse cares passionately about doing his or her job to the best of his or her ability I will adjust the benchmark to something that approaches 'perfect' care...until then I aim for "do no harm".

For the record.  The my usual benchmark is 98% and that is a cliff hanger!


Donna said...

My Dad was in the hospital yrs ago, not long before he passed away...My daughter and I arrived in time to see a student nurse just leaving his room, smiling and nodding at me as we passed each other. Dad was happy to see us when all of a sudden he became incoherent...He had told me before passing out, that the nurse had given him an antibiotic...GEESUS!!!
AND immediately LEFT HIM...
I bailed out of that room, snatched a passing Doctor (luckily) and they brought him back around...Did I demand the hospital fire her? No...I made her watch what was happening, grabbed her by the arm and looked her in the eye and said..."Remember this little girl...You'll NEVER give a Pt. a med and simply walk away...EVER AGAIN...."
She was crying but extremely grateful for the extra chance...
I'll bet to This day, she still remembers what Could have happened!

Oh Lordy girl, wrote a novella again...Hahahaaa
Make them Remember...

WR said...

I am so sorry that happened to your Dad and absolutely she should have stayed at the bedside. Fingers crossedd that lesson will stay with her for the life time of her career! If you don't mind I just may use your tale to share with new orientees! Let me know if you would rather that I did not. Thanks!

Donna said...

Feel free sweetie! Anything to make them remember!!
Happy weekend to you!