Every day of the public inquiry brings another tragic turn to light in the Wettlaufer case. It’s a heart-breaking case of a nurse doing what she wanted without the consequences of her actions being properly monitored and reported:
One of the major gaps seems to have been the siloed nature of the Medication Incident reporting. Each incident doesn’t seem to have triggered the appropriate responses. Each incident doesn’t seem to have been linked with the others. Each incident happened without ringing the appropriate bells. Wettlaufer used incorrect medication administration to kill her 8 victims and nobody was able to link the deaths until it was too late.
The Ministry of Health has made some strides to digitise the process, but it needs to do more. We can’t let these incidents fly under the radar. There needs to be instant triggers. There needs to be nowhere to hide. Pharmacies also need to do more monitor these incidents – they’re the big powers behind the front lines providing these medications and the best practices to the staff at these communities.
The MOH isn’t providing more funding for enough manpower in each of these communities. At least, let’s use technology to ensure the staff we do have are able to do their job as efficiently as possible.