Update on Duke Medical Mistake Case


Eyewitness News 11.com: Duke Awaits Analysis in Instrument Probe:

It's lean healthcare day on the blog, I guess. This is an update to a story reported earlier.

“Bassett received a letter from Duke in January, which said surgical instruments had not been cleaned properly. The instruments were accidentally washed in hydraulic fluid that had been drained from an elevator and poured into a container labeled as detergent.

A federal investigation found that dirty instruments were used for two months, affecting up to 3,800 patients. Medical staff complained several times about the oily instruments.”

Now there's an obvious application of standard work, 5S, and visual controls (with a big dose of training) to help prevent a problem like this from happening again. That's more disturbing is that medical staff noticed the problem. It sounds like management didn't listen and that they are STILL denying the problem (I'm sure the lawyers are telling them that).

Dr. Victor Dzau is the chief executive officer of Duke University Health System. He says the instruments went through other sterilization stages and analysis of those instruments has been completed.

“[The] conclusion is that it is absolutely sterile,” Dzau said.

Ok, Dr. Dzau — would you go in for surgery with instruments that had been “cleaned” in hydraulic fluid??

Please check out my main blog page at www.leanblog.org

The RSS feed content you are reading is copyrighted by the author, Mark Graban.

, , , on the author's copyright.

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn.

Don't want to miss a post or podcast? Subscribe to get notified about posts via email daily or weekly.

Get New Posts Sent To You

Select list(s):
Leave A Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Free Preview! Mark's New Book: "The Mistakes That Make Us"Get PDF Now
+ +