o Southwest Sleep Center offers tips for helping to adjust to the time change: Avoid evening light; see light when you first get up; exercise early in the day; don’t nap too close to bed time, which can disrupt sleep; try to sleep a bit more than usual for a few days to help reduce sleep debt.
o Information about the Clark County Sleep Support Group is available at 360-823-2398.
It’s time for your pill.
But is that according to standard time or daylight-saving time? Does your medication timetable have to spring forward tonight?
Don’t worry about it, advise local hospital administrators.
Apparently, Sunday’s 2 a.m. switch to daylight-saving time will create a little extra work at Southwest Washington Medical Center and Legacy Salmon Creek Medical Center.
Vancouver hospital administrators dispense millions of medications a year and have staffs and information systems that have to be on the job every hour of the year. But things get complicated when it’s an hour that technically never happens or an hour that happens twice, so hospitals are taking tonight’s time change seriously.
For most people with a few pharmaceuticals in the medicine cabinet or a pill bottle on the counter, the clock isn’t as crucial.
“On Sunday, people can follow the same schedule they had on Saturday,” said Vicki Tamis, pharmacy clinical manager at Southwest Washington Medical Center. “That one hour doesn’t matter.”
That pill-osophy applies most of the time in hospital wards, where computer-guided laser scanners ensure the right drug is given to the right patient at the right time.
“With our medication system, we have a ‘due’ time: This is due at 2,” said Becky Juan, an administrator at Southwest. But as far as bringing the medication to the patient, “with our bedside system, we allow an hour before and an hour after the time when the medication is due.”
There are exceptions, though.
“With a few drugs, timing is important: An hour makes a difference,” Tamis said. “There are a couple of antibiotics where you don’t want an hour’s difference either way; that would mess it up.”
In the hospital, “3:30 a.m. is big for diabetics,” Juan said. “Health is linked to tight control of glucose levels. You have your sugar tested at 3 a.m. and if needed, you get a dose of insulin at 3:30 a.m. People say, ‘Whoa: I don’t do this at home.’”
But Southwest has to take extra steps, Tamis points out, because “we give 2.2 million medication doses a year.”
Hospitals work hard to ensure the five “rights” of medications, Tamis said: right drug, right patient, right dose, right timeright route.
“We use this to make that happen,” she said, showing off a pocket-sized device that links a built-in scanner with the hospital’s medical records network.
The nurse scans the bar-code band on the patient’s wrist to make sure it’s the right person. Then the nurse scans the bar code on the drug wrapper to make sure the medication, dose, route and time are correct.
“If anything is wrong, the nurse gets an alert,” Tamis said.
Tonight’s time change will be a bigger obstacle for the hospitals’ information technology systems than for their pharmacies.
“We have to do some manual intervention,” Juan said. “For ‘spring forward,’ the tech services are loading patches on some systems with critical documentation. You can’t chart anything in an hour that doesn’t exist. When you look at it, it’s only a 23-hour day.”
The spring time change can have a financial impact, Tamis said.
“We are required to report quality measures. For pneumonia, antibiotics must be given within six hours of diagnosis. We are paid based on core measures,” she said.
Let’s say the drug was administered within 5½ hours. But if the clock leaps ahead 60 minutes and says it was 6½ hours, “It affects our payment,” Tamis said.
The return to standard time in October has its own issues.
“Fall is harder than spring, because you have a 25-hour day,” Tony Wente, director of technical operations with Legacy Health’s information services.
“Skipping an hour is easier than reliving an hour,” Wente said. When you reset the clock to 2 a.m. “You must make sure the system doesn’t do something twice.”
Becky Juan, the clinical informatics analyst at Southwest Washington Medical Center, concurred.
“In October, we have a 25-hour day. There are two 2 o’clocks, and the systems don’t tolerate that. Just before the first 2 o’clock, we take it down until the system is back to where it should be.
“In the spring, we take it down 10 minutes before the hour and five minutes after. And within the system, there are scripts and patches.”
Those are not particularly busy periods in hospitals, said Juan, a registered nurse as well as an information technology official.
“Patients don’t spend as much time in the hospital as they used to. It’s a very intense experience, and we have to provide periods of rest between midnight and 4 a.m., when we try not to schedule medication.”
Things got even more complicated in 2007, when the federal government changed both ends of the time switch. Daylight-saving time used to kick in on the first Sunday in April; now it’s the second Sunday in March. The return to standard time was pushed back a week, to the first Sunday in November.
“That was a nightmare,” said Wente, whose system includes Legacy Salmon Creek Medical Center. “With a lot of the hardware and applications, the time change is built in.”
The computers knew when the time change was coming and could fall back or spring forward automatically.
“But the shift was a new element. There was no clinical impact,” Wente said, but Legacy’s tech staffers were vigilant until they got past the previous rollover date in April.
All three hospital officials will have other issues this weekend with devices pre-programmed to spring forward in April. We’re not talking about health technology, at least.
“I bought a DVD/VCR combination and I have to manually change the time,” Juan said. “And then in April, it changes itself.”
“My car clock changes at the wrong time,” Tamis said. “I put up with it” until the whole time-change hassle works itself out.
“My alarm clock still does its daylight-saving time change on the old schedule,” Wente said. “I change it manually. I’m not buying a new alarm clock.”
Tom Vogt: 360-735-4558 or tom.vogt@columbian.com.
