Nurse Jackie or the Robot: You Choose

animation2Showtime’s new series “Nurse Jackie” features Edie Falco as a Percocet-snorting nurse with a bad back and questionable judgment.  If art imitates life, you may be pleased to know that hospitals are automating certain nursely duties.  PC World reports that a Thai hospital is now using robots to move around pills and lab test samples such as blood and urine.  The robot PillPicker sorts pills and dosages into individual plastic bags and affixes them with barcodes that identify the contents.  A BoxPicker robot picks out the medicines that a patient needs, labels them with barcodes, and packages them.  The hospital uses a tube system to send the medicine packs to the patient’s floor.  (Unfortunately, the article reports that the robots bear no resemblance to beloved fictional robots like C3PO or R2D2).

The robots reportedly have improved the accuracy of medicine-giving at hospitals.  The Institute of Medicine published a study called “To Err Is Human,” which noted that approximately 98,000 people die each year in the United States because hospital employees gave patients the wrong medicine.  The automated nurses eliminate human mistakes caused by, say, exhaustion, overwhelming workloads, and maybe even Nurse Jackie-style drug addictions.

A note of caution is in order.  First, when machines get things wrong, they get things wrong in a big way.  While a tired nurse may screw up a few patients’ medicines, machines mess them up consistently.  That is both the promise and the peril of automated systems.  Second, as we increasingly trust machines, human beings lose the motivation to check them for mistakes.  The phenomenon of automation bias bears relevance here.  We trust computers to get things right.  Right now, the PillPicker and its ilk are expensive and so hospitals in the U.S. have not yet embraced the trend.  But as costs drop, we may see these robots replace our nurses and orderlies in the future, at least as to certain tasks.  Time may tell whether we would rather have Nurse Jackie pick our pills or not.

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6 Responses

  1. Frank Pasquale says:

    Fascinating. I think that one of the key drivers of automation bias here might be laymen’s lack of comprehension of how a machine can systematically err. We can all understand how Nurse Jackie’s quirks could lead her to shirk or err–but computerized systems are black boxes to most people.

    It reminds me a bit of unfair comparisons between the public and private sector. Sure, the government may exhibit corruption and inefficiency in many programs, but at least there are standard expectations of transparency and accountability. Private companies can use trade secrecy to block investigations. This is one reason why the battle over health reform is not really a fair fight: we can fully investigate and expose the rationing practices of Medicare, but just try getting key data from private insurers.

    Culturally, we also appear more willing to forgive machines. If the robot gives the wrong pill, it might be explained as a “glitch” inevitable in any advanced technology. More often than not, a nurse doing the same would be pilloried as lazy, careless, or reckless.

    I still hope to see more of these machines developed, because the nursing shortage in the US is severe, and is drawing many qualified medical personnel away from less developed countries. As Laurie Garrett noted, “a study recently published in JAMA estimated that if current trends continue, by 2020 the United States could face a shortage of up to 800,000 nurses and 200,000 doctors.”

  2. Are the nurses actually being replaced by robots? I can’t imagine that being the case, knowing all the things that nurses in fact do. And nurses, at least in this country, don’t perform the lab tests, indeed, several of the functions you mention here are performed by pharmacists (and their assistants) in hospitals. And mistakes in the dispensing of appropriate medicines and dosages can arise at several points in the process, not all of them under the purview of a nurse.

    Frank’s point about “many qualified medical personnel [being drawn] away from [so-called] less developed countries” is well taken, although I do wonder if the robotic functions cited above will impinge in any meaningful way on this phenomenon.

  3. My wife has informed me that the pharmacy in the hospital at which she works uses a robot to dispense medication. The pharmacist takes the order from a doctor and programs the robot (and this can be done off site). The tube system has been around for some time now. The hospital still relies on a pharmacist and, indeed, “pharmacy techs.” The robot (the hospital had a naming contest for it, although she can’t recall what name was chosen), as with computers, is constrained by the expertise and information provided by the person programming it. My wife, who is not a nurse but a “unit coordinator” in a nursing station (orders lab work, radiology, nuclear medicine, etc., reads cardiac telemetry monitor; does charting; answers phones, etc.), informs me that many of the new technological devices adopted at her hospital, including the aforementioned, has actually increased her workload by as much as 25 percent!

  4. Matt says:

    Quite a few years ago, when I was an undergrad in college, I worked as a “pharmacy tech” in a hospital pharmacy for a couple of years. We’d had a pneumatic tube system to send out medicine for some time when I worked there, though this wasn’t used for the standing orders for patients- there were just too many of those so we prepared those at night for each patient and put them in bags to be delivered to the floors. I doubt that any hospital uses pneumatic tubes for the standing orders- the systems are just too small for that sort of load. Around the time when I left this job (1996, I think) machines for dispensing medicine were being introduced into the hospital. They were more primitive then the ones described here sound, but they still had to be loaded by humans (pharmacy techs, mostly) and orders had to be entered by pharmacists. The biggest cause of error I saw wasn’t due to nurses but rather doctors with terrible hand-writing who wouldn’t take the time to print, leading to the wrong doses or even the wrong drugs being given. Many of these errors were in fact caught by nurses who realized that the wrong dose or drug was being given.

    Drug use was, alas, far from unheard of from hospital staff.

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