Vol. 26 August 1, 2010 The YELLOW STICKIE Ain’t Dead Yet.

I’m sure that many of us “old timers” can remember the early days of computer implementation in our hospitals. At that time you couldn’t help but notice the dozens (or more) yellow Stickies plastering the nurses’ station computers, usually around the monitor’s edges, filled with keywords, short cuts, new jargon, and other information helpful to them as they strived to give up their dependence on paper. Well, thirty years later, the yellow Stickie ain’t gone just yet.

I had to go into my hospital last week to get an intravenous infusion to help me with the effects of a neuropathy. The receiving desk at the IV Infusion Center had three computer monitors with two people sitting at them. My physician’s orders were already printed out and were attached to my computer printout encounter form. After receiving my computer generated ID bracelet with bar code, I was lead into a room with four chairs, each one next to a computerized infusion pump with blinking lights and various sounds to convey different messages to the nurses caring for me. Each pump had  touch-screen data entry and a multiple color display combined, was capable of at least three distinct alert sounds, and was neatly packaged to fit on a standard IV pole. The combination of four such poles, two automatic blood pressure machines with their display screens and alert sounds, the usual wall of oxygen, suction, electrical outlets, and signal lights, a R2D2-size  mobile air conditioning unit standing in the middle of the floor with its coiled, white PVC exhaust duct winding to the wall, and four brand new baby blue Barca Loungers made me think that this is what a passenger cabin on a space ship would look like.

I was to receive intravenous medication following a protocol of precisely increasing amounts over several hours, so I lay back, opened my book, and relaxed while surrounded by all this reassuring technology.

And then I saw it. There stuck to the top of my chart…right there next to my chair… hardly noticeable…seemingly insignificant in the midst of all this electronic wizardry…nicely framed by electric wires and IV tubing…was a small piece of yellow paper.

A YELLOW STICKIE!

On it was written the settings for the proscribed stepwise increase of my medication.The physician’s orders were computerized. The pharmacy’s filling of that order was computerized. My registration and ID bracelet were computerized. My clinical record for the day was computerized. The correct step-wise increase of medication for my weight had been calculated and displayed by the computer at the nurse’s desk. …But, that computer couldn’t “talk to” the infusion pump computer, so the actual entry of correct information into that infusion pump by a nurse for each of 10 stepwise increases depended on that yellow Stickie.

When my chart got covered by a discarded newspaper the yellow Stickie was temporarily “lost” which caused a brief flurry of nurse concern. It was moved to the blue plastic of the infusion pump which repelled the yellow Stickie in a few minutes. It was next moved to the center of the IV pole itself, and there it stood, prominently and proudly revealing its data for the nurse as she entered the numbers every half-hour or so on the touch screen below. …That is, until the Stickie became unstuck while I was in the bathroom and fluttered silently to the floor, just missing the toilet bowl. An extra piece of scotch tape solved the problem of a Stickie not being sticky enough.

The medication was delivered as on the protocol, so all is well that ends well. My next post in two weeks will review some of the new data on clinical errors associated with computer use. I may title it, “THERE  AIN’T NO FREE LUNCH.”

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