Finding what you want to find!

Standard

beyond a bug's life

“Because I was looking for it”, says Sherlock Holmes, half-patiently, in the middle of an intense fight with Lord Blackwood. He was referring to the poison-tipped fine-glass needle.

While this story had a happy ending, looking for what you want need not necessarily be the perfect way ahead. The neurosurgical team at Tufts had a tough lesson to learn.


They found what they were looking for and pretty much shut out everything else.

While the neurosurgeon had asked for omnipaque, the pharmacist had informed the nurse about the unavailability of omnipaque, and had instead supplied them with two bottles of MD-76, which clearly was contraindicated for spinal infusion. The serious warning saying “NOT FOR SPINAL INJECTION” had slipped through multiple barriers not because nobody was looking for it. Rather because everyone was looking at the positive signs such as being handed over by a trustworthy pharmacist or nurse.

You expect…

View original post 200 more words

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s