Tube Tribulations

I'd imagine almost every large hospital has a pneumatic tube system.  If you walk around in the bowels of a hospital, you'll see the winding plumbing snaking overhead and hear the hurried distant bumping and ringing of a tube flying along on compressed air to it's next destination.  If you happen to be a nurse working in a destination site, the hissing sound that precedes a loud "thump" as the tube drops into it's black receptacle is a audible signal that medications or supplies you ordered what felt like hours ago have finally arrived.

In many ways a tube system is like the London Subway system.  There are various "lines" with transfer points between them.  The transfer points mechanically move the tubes between various lines much the way South Kensington station allows passengers to transfer between the Blue, Yellow and Green Lines.

A pneumatic tube can only handle so much in the way of weight.  Despite the fact that the tube will hold a liter bag of fluid, the weight of the bag can slow the tube in transit and wreak other havoc.  The tube is the preferred delivery method for leg-weary delivery staff.  Despite policies to "hand-deliver" certain medications, delivery personnel tend to push these limits.

Now one particular morning when I was working in our cleanroom, the staff was really upbeat. It was busy, but we were ahead for the day and nailing our deliveries on time.  The phones were blissfully silent, a sign that we were on top of things.  A recent batch of "banana bags" were dispatched to the delivery table, the first one was needed on the medical unit right away and I informed the technician who was manning the table of that fact.  It was not my job to tell her to hand deliver the liter bag of fluid, that was policy, so I walked back in the cleanroom to check on more orders.

Within about thirty minutes, our fortunes changed dramatically.  The phones started to light up with calls from angry nurses.

"I sent that order over an hour ago and I still have not received it!" she blared over the phone.
"Well, I'm sure that it was made and put out for delivery" I replied.

Over and over again, the calls started coming down hotly.  I checked the delivery logs and saw all the medications in question were delivered - tubed to the destinations in question.  Now it doesn't make sense to argue with nurses.  We just duplicated the medications and had one of our cleanroom techs deliver the medication by hand.  Surprisingly, they all came back with the same story "I couldn't find the original dose that was sent up.".  It was a mystery.  And to compound the problem, our supply of tubes was getting low.  The delivery staff put out an overhead page to the hospital to send any empty tubes to the pharmacy ASAP.  None came down.

The morning turned into a really bad early afternoon.  It wasn't until after lunch when the guy from building maintenance came down to the pharmacy and asked me to follow him.  I asked him where we were going and he said "the roof." Now for the life of me I couldn't figure out why we would be going there.  When we walked out the access door to the roof, he said "Do these look familiar?" I was amazed to see almost 50 tubes laying scattered all over the roof, full of the medications we'd been sending up all morning long - now baking in the hot sun.  In the center of the mess was a big sheet metal box - one of the tube transfer stations - with a giant hole blown in the top of it.  "I expect this is the one that did it" he said holding up the now broken polycarbonate tube that reeked of multivitamins and had the withered corpse of a liter IV bag in it.  "now you know why we have policies about tubing things like this!  I bet these were flying out of that there hole like a fountain."

The rest of that week, we were not allowed to tube anything while they got the system fixed.  And despite a lot of grumbling from the delivery staff, we had a lot fewer calls for missing medications coming into the cleanroom.