Chapter 2, Problem 9DQ

Paul O’Neill, former U.S. Treasury Secretary, estimated that arguably half of the $2 trillion a year that Americans spend on health care is needlessly wasted. Brainstorm up to 10 blue-sky ideas to solve the following problems:

1. A typical retail pharmacy spends 20 percent of its time playing telephone tag with doctors trying to find out what the intent was for a given prescription.
2. After the person responsible for filling the prescription determines what they think they are supposed to do, errors can be made even in filling the prescription. For example, administering an adult dose (rather than the dose for a premature baby) of Heparin in a preemie ICU is fatal.
3. After the person responsible for filling the prescription determines what they think they are supposed to do, errors can be made even in filling the prescription. For example, administering an adult dose (rather than the dose for a premature baby) of Heparin in a preemie ICU is fatal.
4. Drugs get distributed at a hospital on a batch basis. For example, carts can be filled on Monday, Wednesday, and Friday. A huge volume of drugs can come back on Monday because they are not consumed on the wards between Friday and Monday, patient conditions changed, or the doctor decided on a different intervention. A technician spends the rest of the day restocking the shelves with the returns and 40 percent of the intravenous materials prepared on Friday morning are poured down the drain.
5. Sometimes the administration of the drug was not done on the agreed schedule, because the nurses were busy doing something else.
6. For every bed in an acute care hospital system, some-one falls during the year. Most falls occur after 11 P.M. and before 6 A.M. Sometimes a hone is fractured, leading to immobilization and then pneumonia.
7. One in every 14 people who goes to a U.S. hospital gets an infection they did not bring with them.