Safety Mantra: Can’t not Don’t

In Patient Safety, safety on December 18, 2011 at 2:24 pm

“Don’t do this..”  has never worked for safety in any industry. For example, in manufacturing, a machine called the punch press took many fingers of workers who were not responsive to warning notices and red lights etc.  Safety was not achieved until the punch press was redesigned such that TWO hands were required on the buttons to start the action of the machine.  Making sure the hands were being used to run the machine prevented hands from being inadvertently left inside the machine (Levinson, 2011).  This is an example of CANT  not DONT.

Safety is achieved by force function eg.  can’t do it any other way but the right way.  Worker vigilance is not reliable or sustainable.  Some other examples of CANT not DONT include the SPIKERIGHT enteral system from Nestle which prevents a tube feeding from being connected to IV access.  more—-

After the Dennis Quad incident, Baxter initially touted clinician vigilance as necessary for safety but then redesigned its high dose heparin to have a warning label that MUST be pulled off before entering the vial so no one can inadvertently give high dose heparin.  Clinical vigilance is DONT  but redesigning the package is closer to achieving CANT.

One final example given by Levinson (2011) involves the mandate that clinicians are always responsible for checking expiration dates.  This is another human failure potential.  Luckily some companies are stepping up to the plate, providing labels that can change color after a certain time. makes labels that change color based on a time period or a temperature, taking the human memory out of the safety process. This label turns red.

**Think about your daily activities as a clinician or look around your environment and see what your DONTS are.  Can any of them be replaced with CANTS?  You just might save a life!

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