[thomasfedb]

Medication errors are common enough that they happen on a regular basis in any reasonably sized hospital. They happen both with or without electronic systems.

The majority of errors are caught — by the prescriber, by the pharmacist, or by the nurse administering — but a few fall through the cracks. Order of magnitude errors, where the dose is x10^n the intended dose are some of the more common errors.

We have a lot of safeguards — for example packaging medications in dosages that are likely to be safe for a single dose — but there are also some factors that make errors more likely, such as paediatrics (who need smaller does), geriatrics (who often have many different medications which can interact), and critical care (where things move fast, and big doses might be needed).

I'm a student doctor, and hopefully you believe me that medicine is hard. Electronic systems might help with some of the hard bits, but they're often a hindrance, or pose their own hidden dangers. As a software engineer I know that a lot of medical software is far from fit for purpose.

[ryacko]

Order of magnitude errors aren't that hard, it is improbable that a hospital will need to prescribe enough drugs for a small horse.

Doctors seem to run too much on autopilot, they leave discretion to laboratories who give recommended ranges for various hormones/vitamins/chemicals in the blood.

I won't disagree that medicine is hard, but this looks like a UX design flaw, the UX should factor in drug company recommendations for dosage per patient weight and present a graph, there should be some method of compare and contrast to recognize an error happened.

[thomasfedb]

> Order of magnitude errors aren't that hard, it is improbable that a hospital will need to prescribe enough drugs for a small horse.

Weight range in children's hospitals ranges from 100s of grams to 100s of kilos - that's three orders of magnitude right there.

> Doctors seem to run too much on autopilot, they leave discretion to laboratories who give recommended ranges for various hormones/vitamins/chemicals in the blood.

Both population biochemistry and laboratory assays vary between hospitals and labs. So it's actually really important that we interpret biochemical results in relation to the normal ranges provided to us by the lab. Also, those normal ranges are not just set by the lab without thought, there are pathologists and clinical chemists involved in the process.

I think we think about these numbers a whole lot more than you think we think about them.

[leereeves]

Doesn't the system know the patient's weight?

[thomasfedb]

Some systems do, but even then not in all situations. In my hospital we prescribe on paper anyway.

[skwb]

Well university hospitals run lots of "experimental protocols" where physicians need the autonomy and flexibility for prescribe all sorts of medications. Just curation of drug-drug interactions tables is a huge butt-load of work, and we do have "hard stops" for all sorts of potentially dangerous interactions.

Ultimately however, you need systems in place to control and regulate these systems (such as pharmacy, nurses, other physicians). Obviously this system had a major failure, but it's why this is the special exception rather than the rule. And for what it's worth, this article (by Bob Watcher, who basically invented hospital medicine) is part of any major graduate level healthcare education.

One of the biggest problems I have seen with tech getting into healthcare is that they seem to forget the human interaction portion of healthcare that mostly happens offline. Yes, technology can have an enormous impact, but you can't just "technology" away all the problems in our current healthcare system.