Check Your Tubes

Posted on September 7, 2010 in Our Blog,Patient Care,Patient Death

My husband had surgery recently, and we were really impressed with the entire hospital staff. Everyone was really helpful, friendly, and efficient. Each person who saw my husband checked his identification wrist band, and everything seemed well organized. Though we had a good experience, I couldn’t help but think about how many individual people were involved in my husband’s care and how easily everything could have fallen apart. One little mistake or miscommunication could have changed the experience.

Hospitals are run by human beings, and human beings make mistakes. That’s why it is so critical that the equipment used in hospitals leave nothing to interpretation and make it nearly impossible for a human to make an error with the equipment, and that’s why I was shocked to read this New York Times article about the lack of standardization with hospital tubes. Tubes are ripe for mishaps because many of them look very similar and are interchangeable and thus get mixed up by hospital staff.

Accurate statistics on tube mixups do not exist, and many believe tube mixups often go unreported. Still, the article noted a 2006 survey in which 16 percent of participating hospitals reported a tube error. For something that usually isn’t reported, that is a pretty high percentage.

So where to place the blame? Though advocacy groups have been pushing for regulation of tubes, in particular that tubes are not interchangeable, nobody seems to want to take any responsibility. Some blame the Food and Drug Administration, which has what some consider to be a dangerous approval process, some blame medical device manufacturers, some blame hospitals, you name it. In the meantime, patients are dying: feeding tubes have been mistaken for intravenous tubes; intravenous tubes have had oxygen pumped through them, a rash of mistakes have been made. Someone needs to set some standards, and someone needs to do it before more people are harmed.