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What you are saying Tim is that no system is idiot-proof - and I can give you plenty of examples of juniors getting the units wrong and mis-interpreting lab results (once every 6 months, mysteriously correlating with the medical and surgical rotations) long before SI units became commonplace in hospital lab practice. Drug results make more sense in SI units and it would be a step forward to move away from the "we've always done it that way" solution to this problem. Nick Miller London On 04/12/06, Reynolds Tim <[log in to unmask]> wrote: > > But when juniors move from one hospital to another and the A&E dept > ignore the units when writing down results, it is a problem. In fact, it > is a systems problem that can be dealt with very simply by agreeing which > units to use on a country-wide basis. > > You could conceive of an airline problem where a plane crashed someone > striped a vital bolt by using UNF instead of BNF gauge threads. It would be > inconceivable that that was not solved. > And before you say that this could never happen, the Hubble space > telescope has a mirror problem because someone specified a particular type > of bolt in the grinder monitoring system, and the other type of bolt was > used, resulting in the mirror being mis-ground. We have the same with drug > measurement. Units are an arbitrary (albeit formalised arbitrary) method of > recording something so that people agree - if they can't agree because they > use different units and someone dies as a result, where does the problem > lie: It lies with the disagreement over units - so the solution is obvious - > agree on the same units. If you can't agree then there should be a decree > from someone in power that the same units should be used for whatever > mission critical system that needs to be fixed. > > So who cares whether we measure in mg/L, mg/dL, mmol/swimming pool or > widgets/employee' Provided we all report in the same units the safety > problem is solved... > > > ************************************************************************************* > Prof. Tim Reynolds, > Queen's Hospital, > Belvedere Rd, > Burton-on-Trent, > Staffordshire, > DE13 0RB > > work tel: 01283 511511 ext. 4035 > work fax: 01283 593064 > work email: [log in to unmask] > home email: [log in to unmask] > > ************************************************************************************** > IMPORTANT: This email is intended for the use of the individual > addressee(s)named above and may contain information that is confidential > privileged or unsuitable for overly sensitive persons with low self-esteem, > no sense of humour or irrational religious beliefs. If you are not the > intended recipient, any dissemination, distribution or copying of this email > is not authorized (either explicitly or implicitly) and constitutes an > irritating social faux pas. Unless the word absquatulation has been used in > its correct context somewhere other than in this warning, it does not have > any legal or grammatical use and may be ignored. No animals were harmed in > the transmission of this email, though the kelpie next door is living on > borrowed time, let me tell you. Those of you with an overwhelming fear of > the unknown will be gratified to learn there is no hidden message revealed > by reading this backwards, so just ignore that Alert Notice from Macroshaft. > However, by pouring a complete circle of salt around yourself and your > computer you can ensure that no harm befalls you and your pets. If you have > received this eMail in error, please add some nutmeg and egg whites, whisk, > and place in a warm oven for 40 minutes. > > > -----Original Message----- > *From:* Clinical biochemistry discussion list [mailto: > [log in to unmask]] *On Behalf Of *Nick Miller > *Sent:* 04 December 2006 11:46 > *To:* [log in to unmask] > *Subject:* Re: Consensus statement on reporting drugs and poisons > > Tim, > > It's absurb to blame the choice of units for the failure of A&E SHO's to > familiarise themselves with the reference range for drugs or any other lab > tests (unless the lab changed the units and reference ranges without telling > anyone - which is unlikely). > > And yes, pharmaceuticals act and interact according to the molarity of > their active components, so SI units are the appropriate choice for > reporting their concentrations in body fluids. > > > Nick Miller > London > > On 04/12/06, Reynolds Tim <[log in to unmask]> wrote: > > > Having heard of a recent death due to paracetamol in a patient because > > the lab reported in mmol/L and the A&E dept interpreted in mg/L and > > discharged the patient, I don't think it matters what we report in provided > > everyone does the same. In this situation we have a proven cause of death > > that could be prevented if everyone agreed to do the same thing - the sort > > of problem that the safety experts always say we should be following > > airline-type procedures to prevent. Since drugs are measured in mg / liter > > it seems reasonable to report concentration in mg/L but what does it matter! > > > > > > Perhaps we should decide to report in ounces/gallon - then at least > > everyone will be united in hating the 'new' units. > > > > > > TIM > > > > > > > > ************************************************************************************* > > Prof. Tim Reynolds, > > Queen's Hospital, > > Belvedere Rd, > > Burton-on-Trent, > > Staffordshire, > > DE13 0RB > > > > work tel: 01283 511511 ext. 4035 > > work fax: 01283 593064 > > work email: [log in to unmask] > > home email: [log in to unmask] > > > > ************************************************************************************** > > IMPORTANT: This email is intended for the use of the individual > > addressee(s)named above and may contain information that is confidential > > privileged or unsuitable for overly sensitive persons with low self-esteem, > > no sense of humour or irrational religious beliefs. If you are not the > > intended recipient, any dissemination, distribution or copying of this email > > is not authorized (either explicitly or implicitly) and constitutes an > > irritating social faux pas. Unless the word absquatulation has been used in > > its correct context somewhere other than in this warning, it does not have > > any legal or grammatical use and may be ignored. No animals were harmed in > > the transmission of this email, though the kelpie next door is living on > > borrowed time, let me tell you. Those of you with an overwhelming fear of > > the unknown will be gratified to learn there is no hidden message revealed > > by reading this backwards, so just ignore that Alert Notice from Macroshaft. > > However, by pouring a complete circle of salt around yourself and your > > computer you can ensure that no harm befalls you and your pets. If you have > > received this eMail in error, please add some nutmeg and egg whites, whisk, > > and place in a warm oven for 40 minutes. > > > > > > -----Original Message----- > > *From:* Clinical biochemistry discussion list [mailto:[log in to unmask]] > > *On Behalf Of *Colley, Michael > > *Sent:* 04 December 2006 09:46 > > *To:* [log in to unmask] > > *Subject:* Re: Consensus statement on reporting drugs and poisons > > > > As activity is molar, I'd go for molar. It's the American Drug > > Companies and the Pharmacists who're the main perpetuators of mass measure. > > > > > > Mrs. X is just as unlikely to understand 5mg. She understands that she > > needs one tablet of A and another of B. > > After all, a 5mg tablet of A weighs a heck of a lot more than 5mg! > > > > Perhaps, using the arguments for mass we should be going back to mg/dL > > for glusoce and all other analytes including sodium and potassium. > > > > Michael (it's Monday morning!!)# > > > > -----Original Message----- > > From: Williams David G (RLN) City Hospitals Sunderland - Clinical > > Scientist [ mailto:[log in to unmask]<[log in to unmask]> > > ] > > Sent: 01 December 2006 14:13 > > To: [log in to unmask] > > Subject: Re: Consensus statement on reporting drugs and poisons > > > > > > Good news then. While I appreciate some of the purists among us may pine > > for > > the mole, I doubt if the likely confusion on the wards and for patients > > will > > do us any good at all. > > > > (Cut to GP surgery "Right then Mrs X, I'm going to prescribe 22.56 mmol > > of Y > > and 347 umol of Z for you to be taken twice daily after meals") > > > > David G Williams > > > > -----Original Message----- > > From: Julian Barth [mailto:[log in to unmask] > > <[log in to unmask]>] > > Sent: 01 December 2006 13:44 > > To: [log in to unmask] > > Subject: Consensus statement on reporting drugs and poisons > > > > Dear Colleagues > > > > I have to date had no real responses regading the proprosal that all > > clinical laboratories in the UK report drugs and poisons in MASS SI > > units. I am very pleased to inform you that the Scottish Senior > > Clinical Biochemists Group have recently agreed that all laboratoies in > > Scotland will be shanging to mass units. > > > > I assume that the total silence means that there are no objections to a > > change in England too, so can we have a discussion about time lines for > > a change over? > > > > Yours hopefully > > Julian > > > > Julian H Barth MD FRCP FRCPath > > Consultant in Chemical Pathology & Metabolic Medicine > > Department of Clinical Biochemistry & Immunology > > Leeds General Infirmary > > Leeds LS1 3EX > > > > tel 0113 392 3416 > > fax 0113 392 5174 > > > > Editor-in-Chief, Annals of Clinical Biochemistry, > > http://mc.manuscriptcentral.com/acb > > > > ------ACB discussion List Information-------- > > This is an open discussion list for the academic and clinical > > community working in clinical biochemistry. > > Please note, archived messages are public and can be viewed > > via the internet. Views expressed are those of the individual and > > they are responsible for all message content. > > ACB Web Site > > http://www.acb.org.uk > > List Archives > > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html > > List Instructions (How to leave etc.) > > http://www.jiscmail.ac.uk/ > > > > ------ACB discussion List Information-------- > > This is an open discussion list for the academic and clinical > > community working in clinical biochemistry. > > Please note, archived messages are public and can be viewed > > via the internet. Views expressed are those of the individual and > > they are responsible for all message content. > > ACB Web Site > > http://www.acb.org.uk > > List Archives > > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html > > List Instructions (How to leave etc.) > > http://www.jiscmail.ac.uk/ > > ------ACB discussion List Information-------- This is an open discussion > > list for the academic and clinical community working in clinical > > biochemistry. Please note, archived messages are public and can be viewed > > via the internet. Views expressed are those of the individual and they are > > responsible for all message content. ACB Web Site http://www.acb.org.ukList Archives > > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions > > (How to leave etc.) http://www.jiscmail.ac.uk/ > > > > ------ACB discussion List Information-------- This is an open discussion > > list for the academic and clinical community working in clinical > > biochemistry. Please note, archived messages are public and can be viewed > > via the internet. Views expressed are those of the individual and they are > > responsible for all message content. ACB Web Site http://www.acb.org.ukList Archives > > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions > > (How to leave etc.) http://www.jiscmail.ac.uk/ > > > > ------ACB discussion List Information-------- This is an open discussion > list for the academic and clinical community working in clinical > biochemistry. Please note, archived messages are public and can be viewed > via the internet. Views expressed are those of the individual and they are > responsible for all message content. ACB Web Site http://www.acb.org.ukList Archives > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions > (How to leave etc.) http://www.jiscmail.ac.uk/ > > ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/