Comments by "" (@crimeandpsychiatry) on "Psychiatrist Analyses Elizabeth Wettlaufer Interrogation u0026 Confession" video.
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@RandomChristianMusings Well, any automated system has its flaws which are exploitable by bad actors. They certainly cut down on unintentional errors and reduce the number of places that medicines could be misappropriated without it being spotted BUT there are ways around some of those units. I obviously won't go into the details of how those work-arounds work. In my opinion one of the key dangers is that if we trust the machine too much and go to single nurse dispensing then we lose the benefits from having 2 humans in the loop, one dispensing and the other double-checking the person dispensing.
My ideal would be something like Pyxis PLUS two nurse with the 2nd staff member either being at an equal level of qualification but from a different unit ( to prevent cliques and cover-ups ) OR from an entirely different discipline altogether ( pharmacy, some form of administrator etc ). That 2nd person is expensive though over time.
Of course we cannot let the perfect be the enemy of the significantly better and so Pyxis is a much better system than what was in place in the nursing homes Wettlaufer worked in. Pyxis would have stopped most of her dodges for getting medication BUT I suspect she'd just have found other ones - like working in the community, home visits etc where medications would have been much more under her control. It would be relatively easy to say a demented patient smashed an insulin vial while it was being prepped and that'd give her enough for an OD or two. So, there are always ways around things if you WISH to do harm. That's why the control mechanisms need, IMO, to be multifactorial - automated dispensing machines, 2nd staff member in the loop from different department or equal seniority + better pharmacy controls, more nurse and doctor training and awareness of the possibility of health care serial murderers AND automated reviewing of mortality numbers by nursing home, shift, who is on shift etc. Between those varied control mechanisms I think you'd stamp out most of this in a way that a unifactorial approach wouldn't work.
Sorry for the long answer but I headed up a regional drugs and therapeutics committee in my country and this was something I gave a lot of thought to when tackling unintentional drug errors and intentional drug "misplacings" - usually due to health care worker substance abuse.
Hope that's interesting and helps clarify the issue for you.
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