Tuesday, March 23, 2010

The "Missing Targets Sign"

Several years ago I had an elderly patient who was an excellent competitive trap-shooter. He came to my office one day with this specific complaint: "Last weekend I was missing targets and losing to guys who have no business beating me". 

He had no other symptoms and had a normal neurological exam, but related that he had fallen a few weeks earlier and sustained a small scalp laceration which was sutured at an ER. His CT scan subsequently showed a subdural hematoma so I referred him to a neurosurgeon for treatment.

When he returned four weeks later for followup he reported,  "I'm fixed Doc, I'm beating those guys again".

Sunday, March 14, 2010

The Health Commission (THC) Bans "Daily" Orders

A new standard for Health Care Organizations was announced today by The Health Commission (THC) [formerly known as the Joint].

As of today, March 14, 2010, in medication orders, use of daily, weekly and monthly are now considered a Type 1 violation of patient safety. Medication orders must be written in this format:

x(quantity) every y(time period in hours, minutes, or seconds); e.g. 10mg every 24 hours, or 5ml every 12 hours.

This new rule is necessary due to thousands of overdoses which began earlier today in hospitals across most of North America. Patients receiving medications scheduled for "daily" or "twice daily" administration were dosed one hour early, exposing them to possible drug toxicity. There will be a ripple effect with further inappropriate dosing of "weekly" and monthly" in the next doses. This phenomenon is thought to comprise a large portion of the hundreds of thousands who die each year of medical errors. This can be seen in that there were no cases in Hawaii or Arizona which have 2 of the 4 lowest mortality rates in the USA.

THC has enforced previous crucial safety standards to protect patients from harm such as banning "qd" in typed as well as handwritten records, requiring writing out "magnesium sulfate" instead of its chemical formula, and enforcing the 24 hour rule for signing physician verbal orders.

Note: an equivalent rule will soon cover other orders such as vital signs, therapy, and weighing the patient.