Comments on: Primum non nocere http://www.medrants.com/archives/2639 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: CardioNP http://www.medrants.com/archives/2639/comment-page-1#comment-104941 CardioNP Fri, 30 Dec 2005 20:33:44 +0000 http://medrants.com/?p=2639#comment-104941 Review of the article text indicates that those facilities with protocols had fewer dosing errors. And therapy given by a cardiologist was associated with fewer dosing errors. What seems to be part of the problem is that weight and CrCl are typically not readily known when ordering the medications. The elderly were prone to overdosing - in part to overestimation of CrCl. So, as the patient is being rushed to have their EKG done within 10 min of arrival, they need to have simultaneous weight and phlebotomy for a chem panel so that accurate calculations for lovenox/UFH or tirofiban can be calculated :) Review of the article text indicates that those facilities with protocols had fewer dosing errors.
And therapy given by a cardiologist was associated with fewer dosing errors.

What seems to be part of the problem is that weight and CrCl are typically not readily known when ordering the medications. The elderly were prone to overdosing – in part to overestimation of CrCl.

So, as the patient is being rushed to have their EKG done within 10 min of arrival, they need to have simultaneous weight and phlebotomy for a chem panel so that accurate calculations for lovenox/UFH or tirofiban can be calculated :)

]]> By: Paul Tabereaux http://www.medrants.com/archives/2639/comment-page-1#comment-104439 Paul Tabereaux Thu, 29 Dec 2005 04:44:54 +0000 http://medrants.com/?p=2639#comment-104439 I find it ridiculous that in our current world of technology that medicine is again in the dark ages. I don't just find this article realistic but likely it under estimates the number of patients who receive inappropriate treatments, tests, etc. while held hostage as inpatients. To think that we have not created feedback loops, automated checks, smart cards or something at individual patient level to maintain a up to date account of their care is simply an embarrassment to our profession. I have sat on these committees evaluating protocols and the fact is that as long as we continue to trust in imperfection of man -- i.e. handwritten orders, verbal orders and even nurse driven orders that rarely find themselves into the actual record of the patients care -- we will continue to be subjected to mistakes that occur at a clearly shocking rate. I find it ridiculous that in our current world of technology that medicine is again in the dark ages. I don’t just find this article realistic but likely it under estimates the number of patients who receive inappropriate treatments, tests, etc. while held hostage as inpatients. To think that we have not created feedback loops, automated checks, smart cards or something at individual patient level to maintain a up to date account of their care is simply an embarrassment to our profession. I have sat on these committees evaluating protocols and the fact is that as long as we continue to trust in imperfection of man — i.e. handwritten orders, verbal orders and even nurse driven orders that rarely find themselves into the actual record of the patients care — we will continue to be subjected to mistakes that occur at a clearly shocking rate.

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