never ending learning...

My past few calls were bad - interrupted sleep q1hly either by the wards or by ED patients. I seldom spent time watching TV lately - mostly busy with my program while waiting for data. The currently phase would be finalized by next week. I would have to meet with the nursing superintendent and head of pharmacy again next week. The progress note and passover note part were completed 3 weeks ago. Although some minor modification is neither - both of the them were running smooth. The order entering and prescription printing part are my current focus. The core was completed last week but after a brief discussion with the head of pharmacy, I was forced to re-write part of the script. The head of pharmacy requested and insisted that the 1st day UD dose would need to be stated on the prescription. Eg: IV Tagamet 1 amp Q8H is not enought it shoule be IV Tagemet 1 amp Q8H 1st day UD = 2 dose(if the order is prescrbed after 8 am).

2 tasks more before I could proceed with the test run in ICU. 1. The list of oral drug were not enter into the database. 2. The re-printing of prescription part need to be revised - serial no. needed for each print out prescription to facillitate the reprinting process. Why test run in the ICU ? well, I am one of the ICU attending physician - more easier for me to implement things. The ICU is a closed unit and manuplating is more simple. The most controversial part is the temporary telephone order. The nurse would need to key in the prescription on request via phone. The ICU nurses are more senior and able to carry out this job without problem. The ICU test run would last for 2 weeks and after the run and review. It would be implemented throughout the hospital. Then I shall move on to another project.

I enter a phase which I ever imaging  - writing computer program .Once, I thought becoming a physician is the last thing that I learnt to be.  But now, I knew more surprise I would get if I keep on the hard wark of learning.....

to helmet or not to helmet....

It was tiring morning..... I was post call and I got a phone from the combined ED down south..

"We had a case of head injury with SDH and we wished to transfer him to your ED", the doctor talked to me over the phone with Cantonese slang. (Hong Kong with ROC citizenship...). I agreed to his request as the ICU was quick empty ... I asked him what was the GCS and wheather the patient was intubated and this was the reply :" The GCS is 6 but he is breathing smoothly, so I don't think he need intubation at the moment...".

What a professional answer I got.... this was what the local people down south derserved. A special fund was set up to upgrade the service the ED service - the doctor was paid RM100/hr and these kind of doctor was hired....

The patient arrived 1 hrs later and there was a nasal airway in his nostril. I took a glance at the CT. The hemorrhage was minimal but there was severe midline shift. I told the family, ops was needed and I needed to intubate him stat.

The guy had short neck and small mouth - short than mine...I tried the oral approach and failed. I did a second look and still failed to visualized the vocal cord. I decided to go for the nasal path. I was lucky as the patient was still breathing heavily. I passed the tube successfully during my first trial. Well, he was up to the OT within 40 min . That is the advantage of a small hospital ... fast and efficient of clearing patient from ED.

I obtained the history and found out that the patient had fallen from his bicycle. He had gone to the famous Kenting beach town with his wife and children. They were doing a joy ride in the morning. Unfortunately the person who rent the bicycle did not provide helmet. He had fallen and knocked over his head... The history had reminded me about a news I saw 2 days earlier - a police who took part in a bicycle ride with his chief. The unfortuante policeman was cycling down a slope a loss control. He was riding with full gear but the speed was too fast and he sufferred from intracranial hemorrhage and cost him his life...

Well - better stick to my helmet(my head ...) and Strida(not the efficient but slow is safe...)   - I am doing my ride consistently and I dont want to end up like anyone of them....

Visual Basic Programming

It had been 3 wks since my last blog... well, I was stucked with a project... Few months ago, I was appointed as second chair to the patient safety committee. The was this issue about the passover of doctors requested by the evaluation board. I was learning visual basic then and I took over the responsibility to write a simple program for this passover procedure. The concept was simple - each attending doctor enter the passover note of relevent patient on the computer and the doctor on call log on to the computer and read the passover then print it out and signed it. The concept was adapted from one of the university hospital. Well, just enter, write into file and read it out and print.... Well, the program took me few months to complete and it was very raw ... the was this obsticle keeping our staff to using it - the biodata of pt - > entering the biodata is not a simple task for people who are not good at chinese input....so eventhough it was ready but it was never in use. Until the last attack visit by the local National Insurance Agency officer - the inspector complaint about different handwriting and not so up to date progress note. So I was thinking of writing a Progress Note Program .... this time, I would need to get access to the hospital database. So after a few discussion with the project manager (our hospital computer system is contracted to a software firm), we had worked out a solution. I was reluctant to do in the past because the hospital would be billed for every task done by the firm. 

 After 6 weeks of effort - the program is currently online.... The Nursing Specialist would benefit from it and hopefully some of the doctors would like it......The passover program was integrated to this program and currently on its 2nd days of test run...... I mastered several skill during the process - mapping drive, cutting a long sentence into different line and accessing database. I am learning as an apperentice programmer and trying to evolve...The health department had started to pushed the concept of "paperless" hospital but it is currently governed by the electronic medical record act - 11 hospital had entered the project but I doubt we should follow.... there is one requirement which is strict - each record enter would need to be transferred to the mainframe of health department - electronically signed and stamped with a date and time then sent back to the local hospital computer before it is saved. That means once the progress note/ order sheet/ nursing note / imaging or whatever could not be altered later..... well, which I dont think is executable at the moment.... My next project is currently the order entry system ... I had a deathline of 2 weeks and I intend to make it...

There are lots of books regarding basic of VB2005 but only few of its talked about advance technique, most of the time, I would need to browse the net to found a solution...