Our Guest: Patches Seely MBA, BSN, RN Healthcare Executive
Registered nurse and advisor Patches Seely makes her return appearance on the podcast! Building on the insightful conversation about healthcare professional diversion in her previous interview, this episode delves deeper into the critical intersection between serious safety events and potential impairment. We explore:
- Parallel Processes? Examining the similarities and differences between investigating serious safety events and suspected diversion cases.
- The Role of Impairment: Unpacking the potential link between impairment and unexpected events, and the varying approaches across healthcare organizations.
- High Reliability Organizations (HROs): Defining HROs and their emphasis on considering impairment in safety events.
- The Power of Proactive Consideration: Exploring the positive implications of organizations that prioritize Substance Use Disorder as a potential cause of safety events.
Join us for this crucial conversation that encourages a more comprehensive approach to healthcare safety.
Transcript:
Terri
Welcome back, listeners, and welcome back, patches. My guest today is patches Seeley. We’ve talked before, and if you did not hear that episode, please go back and listen to that. She shared her experiences with healthcare professionals, diverting at facilities where she was the clinical nurse manager, and she talked about the impact that had on her staff, and she really provided some great insight. So thank you for that, patches, and welcome back.
Patches
Glad to be back. Thank you.
Terri
Today we’re going to talk about the intersection between serious safety events and diversion case reviews. And I think what I’m going to do is start with the definition of an HRO. We touched on that a little bit in our first podcast, but we didn’t have really define it for those that are unfamiliar with it. You gave us a few insights on it. Deference to a more experienced person, I think was one thing that you said, which I think was great, but let’s start with that. So let’s define a high reliability organization.
Patches
Yvette, when I think about high reliability, the best place to start your research is the airline industry. That’s really where the concept of high reliability came into the marketplace. And how do we make air travel airtight, you know, how do we prevent, you know, negative outcomes for our airline travelers? And what they studied, deeply studied, you know, failures and failure points in various policies, procedures, culture inside of the airline industry and set, I would say, a fairly exhaustive list of ways to prevent errors and to hardwire safety tools in their workforce. It really does have to be the entire workforce for an organization to become highly reliable. And that means that we can count on them, you know, first to do no harm. Don’t hurt me. Don’t harm me. Be nice to me. That’s what most people want, right?
Patches
And so the airline industry really did begin to adopt higher liability principles, and that transitioned into healthcare as we began to, in the industry, become more aware of the amount of medical errors that patients face when they’re in our healthcare system. So something had to be done. And many organization have, organizations have adopted high reliability principles. So a highly reliable organization is one you basically can depend on to keep you safe. And that is valued by all levels of the organization. And that even in a highly complex, highly stressed organization or situation, that those, the disciplines of those practices will be carried out and will yield greater safety for our patients.
Terri
Yeah, and I like that. Hardwiring it, right? I mean, we’re all prone to human error, so the more that we rely on the human to do something, the less, the more chance, I guess. We have of something going wrong. But that hardwiring, which is something that we talk about a lot in the pharmacy when it comes to, oh, let’s just say order entry. You know, there was, I’m trying to remember back, there was a medication error that I was reviewing in my role as med safety officer, and most medication errors don’t harm anybody. We can recover from it pretty quickly. And most people, you know, not even the clinicians, as you had said when we talked earlier, realize sometimes that it even happened. But this one was caught, and this one was filed as an error.
Terri
And so going in to review it was a situation where the dose had to be changed for, the frequency had to be changed for somebody, I think it was with decreased renal function, maybe, and this was a med that was known, so you got to make an adjustment. But the frequency was already hardwired in to the EHR for order entry. So it pop up, let’s say, every 8 hours, that was just hardwired, which is not a good idea for a med that needs to be adjusted. And so it may not be Q 8 hours, even though that’s the a standard. Right. If somebody had good renal failure. And so that was the problem. And you could tell that the pharmacist knew that it needed to be adjusted because they added it to their notes.
Terri
So renal function changed to once daily dosing or recommend whatever it was. But yet in the order entry process, they missed that Q eight needed to be changed to once a day. And so that was a case of, wait a minute, you hardwired in the order frequency, but you shouldn’t do that. For a med that requires adjustment. You need to make the person put that in because they just. They missed it. So it almost seems counterintuitive in terms of, well, you said to hardwire, yeah, but not on a med that is regularly adjusted. And so that was a change that then went through the IT department. You know, we need to take this q 8 hours out.
Patches
You’re saying something that’s resonating with me in that when we first opened this discussion, were thinking of human processes that need to be highly reliable. But the way we build our tools around our human right, we have to consider high reliability principles as well there. And that although maybe 80% of patients would need this particular dosing schedule, we need to account for in the way our tech is built that we aren’t forgetting about what that other 20% might need, for example. And so as we develop new tools around the clinical, in the clinical arena, we have to be thinking about is our tech being built and designed with high reliability principles in mind as well, and not become over reliant on the technology, but to make sure that we are still using our human factors tools to mitigate risk for our patients.
Patches
Thank you saying that. And I think that should shape all of our. All of our high reliability conversations.
Terri
Yeah. So from a diversion mitigation perspective, do you see parallel processes for, like, serious safety events and suspected diversion review? Do you see those dovetailing in any way in an HR?
Patches
Yeah, I’m glad that you asked that. Putting on kind of a clinical informaticist hat, which is one that I wore for a period of time. If you think about the beginning of the detection of a diversion circumstance, the reports that you receive, and you know, how you receive those, and integrating that into your daily practices, and integrating a certain discipline around how you review those reports each time. The preoccupation with failure, that is a huge concept in high reliability, is that organizations, individuals, units, departments, areas of service, all have to be preoccupied with the possibility of failure. And in the case of diversion, we have to be preoccupied with that as a possibility. So when we receive that report, we need to be preoccupied with the fact that we may have a diversion situation as we review those reports.
Patches
And so I think the concept of preoccupation with failure is pretty critical to avoid. That’s one intersection, and that’s really at the beginning of the process of the detection of the potential for drug diversion. Whenever we get to the place of maybe interviewing someone, how we conduct those interviews, establishing a posture of empathy, you know, establishing a posture of, we are not looking to find failure in you. We are looking to find facts, and let’s talk that through in such a way that we find factual information as we investigate a case. And then the thing that I see is a glaring miss, is that oftentimes when we investigate serious safety events, we don’t ask about impairment. Is there a possibility that any of the clinicians involved in the care of this patient may have been impaired?
Patches
And does any of this behavior suggest, and then does any of the technology, the reports, the connection between Mar med distribution system, you know, diversion software, is any of this maybe pointing our eyes, we need that filter. We need the possibility of impairment as we discuss serious safety events, and as many serious safety events as I investigated in my time in clinical executive leadership, the conversation never came up. Could these individuals be impaired? Yeah, very good point.
Terri
Yeah, I think it’s a big mess, and I am a huge proponent of, well, education throughout the entire facility. Of course, as to what diversion is, many people just don’t. They don’t think about it. They don’t understand, they don’t have think that it happens in a healthcare environment. I mean, why would a licensed healthcare professional put their patients at risk like that? But we’re human, and these things happen, so people don’t think about it. And I am constantly amazed at conversations that I have with people that have this moment, and it’s like, well, I don’t know. I didn’t think about that.
Terri
So I am a huge proponent of you have to engage your risk department in this education piece of it, because there are going to be things that I don’t know that the risk department does know, because we’re just not privy to that. Right. Especially if it involves a physician, and that’s the whole peer review, behind the curtain thing. But somebody in your organization that is privy to every single event needs to be aware that diversion or just impairment could be factor. And so they need to then be your partner to say, hey, you know, they don’t have to tell you, oh, so and so was involved in a wrong site surgery, but they need to say, can you take a look at the reports for so and just let me know if anything.
Terri
You know, we had an event, and I just want to make sure nothing else is pointing to anything. So, yeah, risk 100% and. And also patient experience or patient complaints or that hotline that patients can call and just do kind of this generic complaint. I’m very unhappy with this. And this happened. That person needs to be aware as well, because that could be a factor.
Patches
I think in the last time were together, Terry, we talked about linking arms. Pharmacy and nursing. Right. As we develop, as we look at diversion cases, you just talked about the linking of arms with multiple departments. There is safety science and our safety science colleagues, our clinical quality colleagues who are already going to be involved investigating errors and incidences. That’s who we link arms with. And circumstances like this to really help us develop the concept of impairment as a filter and, you know, and using that possibility to investigate to additionally, it may not be the full focus of the investigation.
Terri
Right.
Patches
But even to ask the question, is there any possibility that any clinicians involved in the care of this patient that resulted in this outcome? You know, could. Could we. Do we have a situation of possible impairment? And, you know, in most organizations that I’ve had, you know, been involved with, the clinical quality team really does have ownership of, you know, serious safety event investigation and the processes around those. And using our relationship with pharmacy to look at diversion, I think is a critical link that we’ve missed. And to your point, not every, not all accesses are the same. Now, I don’t really know why there’s a just as much danger in a physician, a pharmacist, a nurse, a PT, an RT being impaired.
Patches
There’s risk to the patient either way, but there are certain regulatory and legal boundaries that are different depending on role, but those are accessible. So your processes need to include bringing in those partners so that you can ask that question and get a reasonable response. But we aren’t even asking the question.
Terri
Right. Right. And not from your experience. I’m going to guess not all organizations have that HRO mindset, even though you think that would be. They would, yeah.
Patches
You know, I had the good fortune of having experience in a large healthcare system where the commitment to safety and patient outcomes was, you know, mission integrated. It was funded, you know, the ability to complete a great deal of training for becoming a high reliability organization. But I will tell you, it’s very complex, very difficult, and really is culture dependent. You have to get the right high reliability organization culture into your organization. And that takes an immense amount of leadership will and organizational will, you know, way beyond training. So I had the good fortune of being part of an organization that did training in that space, and I became a trainer inside that organization for high reliability.
Patches
And I saw conversations slow down in many ways because as I’m on the phone with you and we’re having a discussion that may involve a number and a decimal place that I had to make sure that you heard me correctly, Terry, before I went on and carried on that task, that read back, repeat back, small interactions like that can mean big outcomes for the patient if it goes wrong.
Terri
Right.
Patches
But each of those increments of time, you know, is a different way in which clinicians, non clinicians, anyone, you know, spend more time, sometimes it takes a little more time to do the right thing.
Terri
Right, right. And I guess, I mean, if your organization, for anybody listening, that is not an HRO organization, that doesn’t mean that you as an individual couldn’t implement what’s possible within your sphere. Right? So having that slower conversation, not assuming something, asking somebody to expand a little bit on the order or the conversation just to clarify, you know, I guess listen to your gut, right? If something seems a little off or it’s moving a little too fast, or, you know, ask that person to slow down or to re explain, of course they could they might get irritated because, you know.
Patches
Well, there are two, I would say, high reliability principles that come up as you’re talking about that. One is having a questioning attitude there when something seems amiss, have a questioning attitude. I mean, that’s a skill I take forth even in my personal life. Right. Something here does not. My gut. I think you use the term gut like something doesn’t feel right about this situation. Well, there’s a reason that instinct develops. Right? Right. And so there is value in pausing and really looking around you at all of the possible failures for this patient. The other one that you described is how you interact with someone when you’re trying to slow the line, and it’s called ARCC. And ask the question, should we be both validating that this is the right dose for this medication?
Patches
And then if you continue to get pushback, I recommend that we make sure we analyze this patient order correctly. And then, you know, the next c is about potentially the chain of command, all the way up to the chain of command. I’m not going to go forward until we validate that this order is accurate, that process highly reliable. And everybody in the room has to agree that sometimes I may get someone who wants to slow the process, slow the line in order to get this done accurately for the patient. So there has to be organizational will and organizational desire, support from leadership, and I would say mirroring and being an example of that has to happen from all levels of organization.
Terri
Yeah, no, that’s good. Yeah, it’s happened to me before. Fortunately, nothing with a patient safety type of an issue. Probably more of a, should I say this? Should I send this email? Should I go direct to this person? Right. And my guts telling me one thing and I don’t listen to it, and then it comes back to bite me and like, man, I wish I had listened to my instinct. So you’re right. We definitely have to, if something feels wrong, we need to pursue that. And certainly when it comes to a safety risk, and it also, you know, asking the questions, I always tout that every facility with a diversion program needs a champion. And that champion is the person that keeps things at the forefront, you know, ask those questions.
Terri
And that is the person that connects with all of the clinical nurse managers, as we talked about in our last podcast. But also risk, take that time to educate all of the different departments to what diversion is and why it’s, you need to keep it top of mind if anything happens. I think the most unusual way that I was ever alerted of a possible diversion actually came from the billing department. Wow. And they saw. I don’t even remember what it was. I don’t remember what drug or what the situation was, but it had something to do with a medication that was billed on this patient. And I don’t know what alerted them. I don’t know if it’s a duplicate. I wish I could remember the details. But it was the billing department, and they didn’t even know what they were on to.
Terri
They just was like, this is kind of weird. And so they called the pharmacy department. And so then I happened to be engaged in that conversation, and I’m like, yeah, that is kind of weird. And that led down a whole different path. Had nothing, you know, I mean, yeah, fraudulent billing, but that’s what they were focused on. Right. And then it was like, oh, whoa. We have an even bigger problem here. But that was an aha moment for me.
Patches
I bet it was. And that billing agent or billing professional had a questioning attitude.
Terri
Yes.
Patches
I mean, they were employing an HRO principal. They were preoccupied with failure. Something is not right here. I’ve got to do something. I’m not exactly sure what this is, but something isn’t quite right. And they didn’t deny that gut, and they had. Well, it’s about a medication. Let’s call the pharmacy. That’s a start.
Terri
Right?
Patches
To honor that. To honor that. Honor that gut instinct that you’re having. And so they may not have known they were employing on high reliability principles, but in that, tell us even more about educate all departments, you know, assume everybody knows nothing. No one knows anything about diversion, and go talk and share that possibility with multiple departments.
Terri
Yeah. Nobody knows anything. And everybody may have a role. Yeah. You know that a little bit.
Patches
To data integration or, you know, data points. Right. Like using the medication administration system reports, using what’s in the EHR. And, of course, when I was in clinical management, those two did not talk.
Terri
Right.
Patches
It was a manual process to pull all of the data elements together. But your billing software has data that might tell a story around clinical activity. So I think sometimes we underestimate, maybe, where all of the possible data points are that might tell us story about diversion.
Terri
What a great.
Patches
Well, not a great experience, but what an interesting, you know, experience. And good for that individual, too.
Terri
Yeah.
Patches
You know, that’s another thing happens sometimes, is there’s an authority gradient and. Oh, well, I’m not sure the physician ordered this correctly, but I’m not. Should I say that or I’m just a billing agent. I don’t I shouldn’t ask the pharmacy about that. Or this doesn’t seem right, or, you know, wow, am I going to seem, you know, I’m a little afraid maybe to escalate this to a level, you have to eliminate that authority gradient among your team so that they feel empowered to raise.
Terri
Absolutely. Yeah. And it’s also, I mean, you know, the. I don’t know. I think the tendency maybe is to just say, well, it’s a one off. I’m just going to ignore it. Yeah, but that one off may lead to really big changes or really big discoveries. You know, even back to that example of the. The frequency that was in the electronic piece of. I used to really want to dig into every medication error because what is the point of having a medication error reduction program if you’re not looking for ways to reduce the errors? But it’s labor intensive to look at every single one. And is there something we can do to hardwire this, or is it truly just a human error that we just can’t control? And it’s just one of those things that happened to.
Terri
If you’re asking those questions and take the time to look into even the one offs, it’s amazing sometimes what you can discover.
Patches
So, Terry, when you were in practice inside of a provider organization, and how many times did you ever get brought into, whenever you were specific to your work, was specific to diversion, brought into a serious safety event or a root cause analysis program? Or did organizations that you work for maybe begin to change that a little bit, or are you, do you validate what I experienced and that we never really even measured the two?
Terri
Yeah, it didn’t really. So when I first, the first organization that I worked in, where I was involved in diversion monitoring, I had no integration into any other serious safety events or anything like that. The second organization, I was in the position of medication safety officer and Ops manager, and I was overseeing the diversion program. So then I was brought in for some things, but it was in that position that I was very proactive with risk. Having that conversation is like, look, I know you can’t tell me everything that’s going on, but I want you to be aware that there might be something going on and developed that relationship where it even was to the point where I could call them and say, okay, I have been auditing and it usually was anesthesia provider.
Terri
Just because, you know, that’s what we’re really not going to hear about. It’s like, look, I’ve got some numbers on this provider that I’m not quite sure. But I’m going to give you their name. You’ve got the rest of the information. Do with it what you will. If there’s anything else going on with something in the or that you have heard about. So we did in those cases, and I would hope that, you know, they kept that in mind. Now, did they ever come the other direction and say, hey, we need to look at this? I kind of feel like once maybe they did, but I don’t know what became of it because that is not shared, of course, but it was a nice role to be in because I did have that larger picture.
Terri
I saw what was happening on the operations side of pharmacy. I saw if the technicians would be like, why do I have to keep refilling this non controlled substance medication, perhaps that can be used to substitute for or to combat withdrawals. Why does this keep, like, running out when it’s not really running out? Right. But it was an afterthought. Yeah. I don’t care how many times I tried to tell them, let me know if you see, you know, but you’re just having a conversation, and then it’s like, oh, yeah, it’s like, really? Like, you should have, like, come to me proactively with this. Exactly. So it was a constant re education.
Terri
You know, if somebody calls and tells you that they opened up the automated dispensing machine and there’s a broken vial of, you know, all you have is the ampule or the, you know, and I guess it’s kind of wet. It’s like, okay, you need to tell me about these things because that could be a bigger picture. Yeah, but it is a constant re education. I just. I don’t know. People don’t want to go there, I guess, and think about that.
Patches
I can’t get this phrase out of my head. Is the preoccupation with failure and sensitivity to operations or to, I would say, high reliability principles. But training a workforce to have a. And I would say training a workforce and building a culture around preoccupation with failure is really tough to do. I mean, there are lots of people in an organization, lots of individuals in an organization. You describing the associate who refills the pixis or the omnicell or whatever, your delivery, drug delivery tool of choices, and noticing those strange variations from norm. So same phenomena happens in nursing. We have to recognize the small variation from norm, and then we have to be sensitive to the operation and be sensitive to the fact that for them, in that moment, it may not trigger anything.
Patches
But what escalation processes do we have in place so that those nuances, those small changes from normal policy, procedure, process, whatever is escalated, like, are they. Will they escalate? Do we have those policies and procedures to escalate? Do they escalate if we have them? Doesn’t mean anything if there’s no culture to do it? Or am I afraid to escalate those nuances? In a highly reliable organization? It is. That preoccupation with failure has got to just be running in the back of everyone’s mind and, wow, this is not right. This is not quite usual. I need to escalate this, right.
Terri
And to have one person, you know, you don’t know everything else that’s happening, but if that. If there’s one person that does and something unusual happens and you go to that point person, they can connect the dots of three, four, and five that also happened and start to recognize that pattern. But individually, we’re just focused on the individual. Oh, that’s never happened before. Oh, that’s a one off, or that’s kind of weird. And that’s that. And then nobody knows about it.
Patches
Yeah.
Terri
Yeah.
Patches
Well, I love the idea of the intersection between serious safety events and the consideration for diversion.
Terri
That’s a topic. It has to be. It really has to, you know, take some sort of a look at the people involved just to see if there are other data points that would point to it. I mean, it doesn’t even make sense to me that there’s a major safety risk and that’s not considered. Yeah.
Patches
And, you know, I wouldn’t want, you know, any of our listeners to think, wow, that feels very punitive, like you’re just looking for people to fail. And that really is not the intent. It really is. We’re missing an opportunity to help someone, maybe move into a recovery journey. And at the end of the day, the population we have the first responsibility to is the patient, and to uphold our own patient safety commitments. As individual clinicians, we sometimes will have to ask those hard questions. Let’s look at the team. And is there any evidence of impairment? But it may seem like a punitive posture, and that’s not consistent with HRO principles. In HRO organizations, you really are looking for process failures, system wide failures, not individual failures. But if we have an impairment case, we have to look at that, too, as a system failure.
Terri
Yeah, absolutely. Good point. Yeah. And I, you know, for those that listen to my podcast regularly, I think they know that because I am all about, you know, helping. It’s a patient safety. It’s a staff safety and it’s a facility liability. But you’re right, it sounds punitive and it, I mean, it is to the extent that you need to remove them from the patient care because it is not safe. But ultimately, as we hear from people who have had a substance use disorder and get into recovery, that thing that kind of brings it to the head when they get caught, oftentimes it’s like, oh, finally, you know, or maybe that’s not how they feel then, but as they get into their recovery journey, then it’s like, thank you.
Terri
Best thing that ever happened to me, because, you know, the outcome is often that person is dead, whether on the job or later at home. And so we need to find them as soon as possible. But certainly if it has impacted a patient safety issue, then we need to stop that immediately. So we need to find it. Yeah, there was something else I was thinking about, and now I’ve lost my train of thought. But, yeah, I think there are many positive implications for organizations that do keep a possible substance use disorder at top of mind when it’s looking at unexpected events.
Patches
Well, I think that something that, you know, the prevalence of substance use disorders, and I wouldn’t dare speak to the statistics because I’m uncertain. What I do know is that there have been a, there is a rise in mental health issues. We see it in our patient population, we see it in our clinician population. I don’t think there’s any area of healthcare where we aren’t seeing the rise in virtual mental health. And so it stands to reason that we may see more clinicians as the microcosm of the larger population. Right. Struggling with some type of mental illness.
Patches
And I worked in mental health long enough to know that dual diagnosis is very real, that perhaps you have a mental health diagnosis and that substance use isn’t far behind that, because maybe you’re using, you know, using medications, drugs, alcohol, so forth, a drug of choice, so to speak, to, as a coping mechanism. And so I would stand to think that we’re maybe more aware of mental health and substance use issues, but we also have an increasing number, so we really should be putting processes in place that make sure that we’re looking at the possibility of impairment when we look at a serious safety event.
Terri
Yeah, absolutely. And then you add access on top of it. If your drug of choice is something that you have access to. I remembered what it was. Patient interviews. Do you do patient interviews about their care? And that’s where you sometimes learn about bad care that might also indicate some sort of impairment or diversion piece of it. Do you find that they have a larger role in an HRO organization?
Patches
Yeah. And most organizations that implement HRO are also deeply valuing patient experience. Right. And there’s evidence to show that patient rounding is a valuable tool to improve patient experience. And so the discipline of. And in my experience, we have used the clinical manager role or a more senior nurse of the supervisory role to. To conduct patient rounds. Maybe not on 100% of the patients, but some percentage of patients with a disciplined interview style looking to cover all of their experience and conversations about the quality of the care that’s being delivered are going to come up. If we’re doing good, active interviewing skills with our patients, then those stories should arise. And it’s expected that follow up is done on those patients, trends are evaluated, and follow up is done on those patient experience interviews. And so a highly reliable organization is definitely doing that.
Patches
But I’ve seen a lot of organizations that maybe aren’t considered high reliability or haven’t gone through full training, but they still do patient interviews because patient experience is such a critical topic as, you know, patients or consumers, they’ve already looked to see how, what the quality of your organization is. So we want to make sure they leave with a good experience, you know, rather than a bad meme that never ends. Right. Bad for us, always sticks a little longer.
Terri
Yeah. No, but I think, you know, for the organizations out there that are doing patient experience interviews, that is an easy addition to add a few questions if they’re not already there, but to educate those that are doing those patient interviews, add the questions that can get to the root of, you know, did you get all the medications that you were supposed to get and to kind of fine tune it. Sometimes even, you know, if they’re, if staff are used to seeing people go in and do the interviews, it’s easy to. Then I think we have a problem with this particular caregiver to insert some extra interviews that are a little bit more pointed because they’re already used to people interviewing.
Terri
But if you educate those that regularly do those interviews, to be kind of pointed about some questions, don’t want to scare the patients, but, you know, because you’re going to learn some things. You know, I’ve been surprised in the past, wherever there’s been perhaps an audit done and some concerns about somebody. And so it’s like, okay, now we got to start this full investigation, and then somebody decides to go interview a patient because they haven’t been interviewing any patients. And the patient comes out with, oh, yeah, my meds never work when Mary’s my nurse, you know, and it’s like, why didn’t the patient come forth with this? Yeah, number one. But number two, nobody’s ever asked. And so look what you would have found out had you asked.
Terri
So I think that, you know, for the listeners out there that don’t work at an HRO organization, it doesn’t mean you can’t implement some of these things and take some of these things back to your people. Engage your risk, engage all of your departments in understanding even the billing department and understanding what diversion is and then getting those patient interviews beefed up a little bit if you’re already doing them. And if you’re not, then, you know, consider starting some, but start some, that.
Patches
Very open ended question around, you know, tell me about how your medications are working with you and depending on the answers to this. So conditional logic, you know, if there’s answer that’s given this way, well, then you explore a little bit later. But I think what you’re suggesting is use the possibility of impairment as a filter for the types of questions that you might explore with a patient. And again, in the spirit of good patient care, that’s the spirit of it. It’s not designed to be punitive, but just really understanding. And sometimes you may have a patient who can tell you more of the story than you expect, and you might learn that clinically, something is just not working for them, and you need to correct that, too.
Terri
Absolutely. Absolutely. Yeah. You can learn all kinds of things by, you know, talking to patients. I had talking to a patient once. They. They called me up on the floor because this patient was wanting to do their own insulin with their own reusable needles. Reusable needles. And, you know, it’s like, Terry, you know, talk some sensitive, this patient. But in that conversation, you know, I’m looking at their profile, and they had a benzodiazepine on their profile. It was a standard, you know, admission orders. Right. And he’s like, I don’t use that. They asked me, I don’t use it. It’s like, well, why is this on the order? You know, so nobody was diverting, nobody was taking advantage of it. He was a little bothered by being asked all the time, but it’s a risk for diversion when it’s on that profile.
Terri
So just take it off. Just take it off. Yeah, but those are things that all.
Patches
You can learn, safety, risk. And you’ve solved the patient experience issue, because now you don’t have to ask the patient the same questions and burden them as they’re trying to heal. Yeah, we got work to do. We got a lot of work to do.
Terri
We do job security. All right, patches, thank you very much for your time today. I really appreciate it, and I enjoyed the discussion same.
Patches
Thank you so much. It was great to be here.
