Checklists and Procedures

| posted in: nerdliness  processes 

As a programmer / site reliability engineer / cloud infrastructure administrator I am very familiar with processes and procedures. Some are anecdotal and others are formalized. The best ones are automated, so that they are precisely repeatable.

My wife is having hip replacement surgery today. As with her first hip replacement last year, there are a number of processes and procedures at play, and a few checklists. We both appreciate the thoroughness of the preparation. Having each stage mapped out, knowing what to expect, and having people verify and explain as they go, all make the experience better.

One of the procedures requires no food or drink within six hours of the surgery. Usually they tell you nothing after midnight, regardless of the procedure time, as it is a definite, unambiguous time.

As a part of the pre-op preparation, there were several pills my wife needed to take. She is unable to swallow pills using water alone. We explained this prior to the first surgery to the hospital intake nurse, to the anesthesiologist who called the day before, and to the nurses preparing her for surgery. In order to swallow pills my wife use a small bite of soft food: a cracker chewed up, or a bite of banana.

On the morning of the first surgery the nurse presented her with a little cup full of pills and a small cup of water. We explained once again the inabilty to swallow with only water. So the pills didn’t happen.

We explained this requirement again during all of the pre-op visits and calls. During the pre-op anesthesiologist phone call yesterday, we again explained about the need for a small bite of soften food to swallow pills. This morning we explained that to the nurse. She offered a saltine cracker, which did all the pills to be taken. An hour later, as we were waiting in the holding bay outside the operating room, we were told that due to the cracker surgery would have to be delayed. By six hours.

The procedure wasn’t followed. Had the nurse contacted the anesthesiologist for today’s surgery and asked, it might have been allowed, or they may have said, “Nope, no food”. Either way the surgery would have happened at the original 9 am time. Since there wasn’t any communication to verify the use of a cracker, the surgery was delayed.

I understand and appreciate the importance of procedures and checklists, and that there are consequences for not following them. That the surgeon and anesthesiologist are paying that much attention bolsters my confidence in their focus and dedication to my wife’s care.

The consequence of not following the no food edict is a six hour delay. The irony is that the efficacy of the medication taken at 7 am with a bite of cracker will have worn off by the start time of the delayed surgery.

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Mark H. Nichols

I am a husband, cellist, code prole, nerd, technologist, and all around good guy living and working in fly-over country. You should follow me on Mastodon.