Dennis Quaid and consent-oriented care

We just watched a video on the Dennis Quaid twins heparin error (we've seen umpteen of these during nursing school, but this apparently is new), where they received adult (1,000 units per ml) doses instead of pediatric doses (10 units per ml). This time something occurred to me that hadn't before. We don't explain medications and dosages enough when we're administrating them—if at all. That might have prevented this error, since apparently they were present for one of the doses. If a nurse had to explain what he or she was giving, they might have checked twice at the label. But maybe not.

When my wife and I had midwives for our births, they were very consent-oriented, much more than hospital staff ever is. They asked if she wanted to take things. They recommended rather than commanded. They explained mechanisms of action and effects. The biggest contrast I saw was with vaginal exams - do you want one? It's okay if you don't. Of course, a midwife doesn't have the same necessity of documentation, patient load, and having to give status reports to the OB, which prompts her to say "I'm just going to do a vag exam now"—in effect, obviating consent. Every day I see nurses who say "I have your meds now" rather than framing it as a question or waiting for an answer, or even doctors who obtain consent without really waiting for a yes or a no. We unofficially bypass consent a lot in nursing—I know from experience it's easier to get someone to take a med or have their blood taken if you simply state you'll do it, instead of asking. We have to in the hospital environment. But I also see lots of minor errors, such as drawing blood on the wrong patient, and I've seen some major ones, including heparin overdosages and Coumadin overdosages. If hospitals allowed us to make our tasks human-centered rather than documentation-centered and high-patient-load-centered, that would help avoid errors like these.

I know we're too busy in the hospital to do this. You can't play the home midwife with seven sick nursing home patients and their crazy families on the hospital floor. But I think ideally we should center our med administration around patient (or parental or power-of-attorney) consent rather than just trying to get them all passed as quickly as possible. Of course, that means lower patient loads for nurses, which is another whole ballgame.