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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 0RBwork tel: 01283 511511 ext. 4035
work fax: 01283 593064
work email: [log in to unmask]
home email: [log in to unmask]
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-----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 poisonsTim,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 MillerLondonOn 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 0RBwork 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 poisonsAs 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-----Scientist [ mailto:[log in to unmask]]
From: Williams David G (RLN) City Hospitals Sunderland - Clinical
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
------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/-----Original Message-----
From: Julian Barth [mailto:[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 3EXtel 0113 392 3416
fax 0113 392 5174Editor-in-Chief, Annals of Clinical Biochemistry,
http://mc.manuscriptcentral.com/acb------ACB discussion List Information--------
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------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/