1) The Mysterious Black Hole
1) The mysterious black hole.
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Yes. The mysterious black hole.
Ask any hospital staff pharmacist and he/she will know what you are talking about.
By my estimation, there is a realm of existence somewhere in the unknown universe where millions, possibly billions, of unit dose medications are floating around in the vacuum of space - lost in time from all of humanity for the rest of eternity. Perhaps we have allowed Marvin the Martian to come to discover Viagra.
There is this bizarre phenomenon that is observable at every hospital I've ever been to...and it seems to be an issue everywhere.
Pharmaceutical products, while in the institutional setting, have the physical chemical property of vanishing from the face of Earth. And not just the pharmaceutical itself, but the packaging, labeling, and every physical record of its existence.
Case in point, every day pharmacies compound IVs. Say a physician wants to be a dick and order a bag of IV fluids that aren't commercially available as a precompounded bag. Say, D5 1/3 NSS w/ 30 of KCL. Then say it's 8PM. You are the only pharmacist around and you're one technician is about to go on a round. You have the tech make it and it goes with her on the round. Now the ODDS of that bag of fluid finding its way to the mysterious, evil black hole are roughly 40%. You will sign off on the bag. The tech will put the bag on her cart. The cart will leave. 15 minutes later, a nurse will call you. They will claim your tech has been by and the IV isn't there. So what happened to it? The mysterious evil black hole got it. It happens that fast. So you have to personally go back and make another one while the tech is gone because you don't want the patient with a K+ of 2.8 to suffer. Of course when the tech comes back, she SWEARS she put it in the med drop-off box. You have no reason to doubt her. Just in case, you send her up to investigate the med room. Sure enough, it's not there. And that solves it. The black hole strikes again
Artist's rendering of The Mysterious Black Hole. circa 2009. Note the high percentage of items that are expensive or take some time to compound. According to Mike's First Postulate, 1 minus the product of 100 divided by the cost of a product in dollars times the number of minutes it took to make said product is the probability of that product disappering into the mysterious black hole. Take the TPN for example. 1-(100/[$99 + 35 minutes]) ~ to a 25% it will go missing. Any drug with a probability of less than 0 can be assumed to not have this property. Mostly because nobody cares enough about them to become irate if they go missing.
However, the most...well...mysterious property of the mysterious black hole is that the status of each item appears to be transient in nature. They have the tendency to magically reappear the next morning when the techs go around to round up the unused meds from the night before. Where did it go, how did it get there, why did it go there...nobody knows...but there it is. Back from it's mystical and wonderful journey to the center of somewhere...back to the exact same spot it was put 14 hours ago.
Some may say, "But Mike, perhaps they were just misplaced." Bullshit. There is no way in hell a person can misplace a gigantic-ass TPN the size of a small table. It's an unfathomable thing to happen. And we all know that nurses are bright people that never make errors and have IQs well above 140.
Another interesting phenomenon are the types of drugs that never seem to magically reappear from the mysterious black hole. These usually include drugs that are remedies for common ailments. For instance, I usually observe a 5-count sleve of azithromycin missing from the Pyxis. Or perhaps a patient's Advair discus went missing before it ever got used once. Or perhaps a Lantus pen went missing.
Some may say, "But Mike, those items were probably just embezzled by nurses that are too cheap to get a script for a Zpak or are too cheap to actually be expected to buy their own maintenance medications." Ha, fools. Clearly the martians that live near the mysterious black hole are using them. It is perfectly reasonable that they have bacterial infections or suffer from asthma. We all know that nurses are the most trusted profession on Earth. The Gallup Poll says so. They would never, ever lie about where the meds went or, *gasp* steal them. Sure, nobody would ever find out, the pharmacy never keeps track of which meds go missing, and the temptation to take them is gigantic...but they are NURSES. They would never, ever do anything wrong. Ever.
The mysterious black hole. One of the things that make hospital pharmacists irate.
-----
Yes. The mysterious black hole.
Ask any hospital staff pharmacist and he/she will know what you are talking about.
By my estimation, there is a realm of existence somewhere in the unknown universe where millions, possibly billions, of unit dose medications are floating around in the vacuum of space - lost in time from all of humanity for the rest of eternity. Perhaps we have allowed Marvin the Martian to come to discover Viagra.
Marvin after visiting the mysterious black hole.
So what the hell am I talking about?There is this bizarre phenomenon that is observable at every hospital I've ever been to...and it seems to be an issue everywhere.
Pharmaceutical products, while in the institutional setting, have the physical chemical property of vanishing from the face of Earth. And not just the pharmaceutical itself, but the packaging, labeling, and every physical record of its existence.
Case in point, every day pharmacies compound IVs. Say a physician wants to be a dick and order a bag of IV fluids that aren't commercially available as a precompounded bag. Say, D5 1/3 NSS w/ 30 of KCL. Then say it's 8PM. You are the only pharmacist around and you're one technician is about to go on a round. You have the tech make it and it goes with her on the round. Now the ODDS of that bag of fluid finding its way to the mysterious, evil black hole are roughly 40%. You will sign off on the bag. The tech will put the bag on her cart. The cart will leave. 15 minutes later, a nurse will call you. They will claim your tech has been by and the IV isn't there. So what happened to it? The mysterious evil black hole got it. It happens that fast. So you have to personally go back and make another one while the tech is gone because you don't want the patient with a K+ of 2.8 to suffer. Of course when the tech comes back, she SWEARS she put it in the med drop-off box. You have no reason to doubt her. Just in case, you send her up to investigate the med room. Sure enough, it's not there. And that solves it. The black hole strikes again
Artist's rendering of The Mysterious Black Hole. circa 2009. Note the high percentage of items that are expensive or take some time to compound. According to Mike's First Postulate, 1 minus the product of 100 divided by the cost of a product in dollars times the number of minutes it took to make said product is the probability of that product disappering into the mysterious black hole. Take the TPN for example. 1-(100/[$99 + 35 minutes]) ~ to a 25% it will go missing. Any drug with a probability of less than 0 can be assumed to not have this property. Mostly because nobody cares enough about them to become irate if they go missing.
However, the most...well...mysterious property of the mysterious black hole is that the status of each item appears to be transient in nature. They have the tendency to magically reappear the next morning when the techs go around to round up the unused meds from the night before. Where did it go, how did it get there, why did it go there...nobody knows...but there it is. Back from it's mystical and wonderful journey to the center of somewhere...back to the exact same spot it was put 14 hours ago.
Some may say, "But Mike, perhaps they were just misplaced." Bullshit. There is no way in hell a person can misplace a gigantic-ass TPN the size of a small table. It's an unfathomable thing to happen. And we all know that nurses are bright people that never make errors and have IQs well above 140.
Another interesting phenomenon are the types of drugs that never seem to magically reappear from the mysterious black hole. These usually include drugs that are remedies for common ailments. For instance, I usually observe a 5-count sleve of azithromycin missing from the Pyxis. Or perhaps a patient's Advair discus went missing before it ever got used once. Or perhaps a Lantus pen went missing.
Some may say, "But Mike, those items were probably just embezzled by nurses that are too cheap to get a script for a Zpak or are too cheap to actually be expected to buy their own maintenance medications." Ha, fools. Clearly the martians that live near the mysterious black hole are using them. It is perfectly reasonable that they have bacterial infections or suffer from asthma. We all know that nurses are the most trusted profession on Earth. The Gallup Poll says so. They would never, ever lie about where the meds went or, *gasp* steal them. Sure, nobody would ever find out, the pharmacy never keeps track of which meds go missing, and the temptation to take them is gigantic...but they are NURSES. They would never, ever do anything wrong. Ever.
The mysterious black hole. One of the things that make hospital pharmacists irate.
posted by --==-- | 10:19 PM
3 Comments:
You got that right. It happens every single day.
this is very true. my favorite is when we send up pancrelipase and the patient is supposed to take 15 tabs with each meal and then I find the bag still there the next day on my rounds and when I ask if the nurse gave it, she says yes. Where did you find 15 pancrelipase tabs laying around that WERENT in the pyxis???
lol. Well, they could have been misplaced. I mean if they were used then they probably would be empty. My pharmacy technician training has taught me on how to always make lists to be sure on where things are and how many of them are there.
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