I must emphasize that the technician knew what 600 mg and 0.6 g meant.
The problem lies in the mental facility needed to mentally switch
between the two just as in dollars and cents. Expressing 600 mg as 0.6 g
caused her to panic. In the USA, SI is a "second measurement system" in
the same sense that English is a second language to many Hispanophones.
Had all of us grown up in the USA by being taught about the bouncing
decimal point in measurement, this would not pose a problem, because SI
would be our native system. Even with the certification now required in
the State of Texas for being a pharmacy technician, SI does not become
the tech's first measurement system.
I think I mentioned on this list before about my encounter with a
decimal point at a young age. It was in the Boston Public Library, where
fines for a lost library card were listed as follows:
adult $.25
child $0.25
I could make out the child's fine, but why, I asked, is the adult fine
so many times more---25 dollars, it looked like? Don't know why they
couldn't say that 25 cents was everybody's fine, but this particular
list baffled me for a couple of years, until one day, better enlightened
by decimal placeholders, I understood $.25 to be simply a poorly written
expression for 25 cents.
Pat Naughtin wrote:
>
> Dear Paul, John and All,
>
> I think John is being a little harsh in condemning the pharmacists in these
> transactions - the medical staff (health professionals) also play a major
> role here.
>
> Naturally I can't speak for the USA, but my experience here is that doctors
> and nurses are almost universally ignorant of SI in Australia. The battle
> through their numerical days with a mishmash of units from old imperial
> sources muddled together with cgs, mksA, and other specialist medical units
> of their own devising.
>
> Leave the pharmacists alone John, they are probably the best of a bad lot.
> But having said that I am reminded of an old Bushies' (Australian rural)
> line: 'Just because it's the best, doesn't mean it's any good!'
>
> Cheers,
>
> Pat Naughtin CAMS
> Geelong, Australia
>
> on 07.01.2001 11.22, Paul Trusten at [EMAIL PROTECTED] wrote:
>
> > Sounds simple enough, but it's not in the cards. We do take a
> > calculations quiz as part of our initial licensure exam, but there are
> > no mandatory continuing education requirements for an annual or even
> > period repeat of a pharmaceutical calculations exam. Some states require
> > pharmacists to take a continuing education program in pharmacy law as
> > part of their annual continuing education requirements for relicensure,
> > but I have never seen a mandate for a closed-book periodic
> > re-examination of calculations skills.
> >
> > What had happened in the instance that I once mentioned here was that
> > the technician was mixing a chemotherapy product, which is done so
> > carefully that even a different unit of measurement causes a tiny bit of
> > confusion. She wanted to see 600 mg, not 0.6 g, on the label, and I had
> > labeled it just the way the doctor ordered it: 0.6 g. We customarily
> > label the product with the same name and the same units ordered by the
> > physician. I was a bit surprised that she could not accept 0.6 g as a
> > unit to work with.
> >
> > kilopascal wrote:
> >>
> >> 2001-01-06
> >>
> >> Maybe the only way to solve this problem is to revoke the licenses of
> >> pharmacists or pharmacy techs that do not show a working knowledge in SI.
> >> Those who are in training must show both written and oral knowledge of the
> >> workings of SI in order to get a license and those already licensed must be
> >> tested yearly to show they can function in proper units, symbols and
> >> inter-conversions. Those that can't are OUT!
> >>
> >> This lack of knowledge may be a source of pride to those opposed to metric,
> >> but it is a danger to those who could die from the wrong dosage. Why
> >> doesn't anyone see the seriousness of this? Why isn't someone at the top
> >> seeing a crisis situation here? It seems we as a nation are priding
> >> ourselves in our freedom to be stupid, and we get angry when someone tries
> >> to educate us and make us smarter.
> >>
> >> And to think if medicines were in the old system, the situation would be
> >> worse. Maybe there isn't enough lawsuits to force the issue.
> >>
> >> Glückliches Neues Jahr!
> >> Happy New Year!
> >>
> >> John
> >>
> >> Keiner ist hoffnungsloser versklavt als derjenige, der irrtümlich glaubt
> >> frei zu sein.
> >>
> >> There are none more hopelessly enslaved then those who falsely believe they
> >> are free!
> >>
> >> Johann Wolfgang von Goethe (1749-1832)
> >>
> >> -----Original Message-----
> >> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On
> >> Behalf Of Paul Trusten
> >> Sent: Saturday, 2001-01-06 15:22
> >> To: U.S. Metric Association
> >> Subject: [USMA:10296] leading decimal
> >>
> >> I can state from experience that a leading decimal point can be harmful
> >> of even fatal in healthcare. But, there is a general decimal illiteracy
> >> in US society, one that affects doctors and nurses. In fact, as I
> >> mentioned on this list in the recent past, a co-worker of mine, in
> >> pharmacy, could not easily convert grams to milligrams and vice versa.
> >> The decimal illiteracy usually shows up in the dosing of levothyroxine,
> >> a thyroid hormone supplement, which is often ordered in both milligram
> >> and microgram doses. Often, the dose 0.025 mg gets mis-transcribed as
> >> 0.25 mg, or the drug is ordered as 250 milligrams instead of 250
> >> micrograms. Despite being the innovators in decimalizing currency, we
> >> Americans have a clear lack of facility in thinking decimally.
> >>
> >> But, I think I was lucky in attending the Boston Public Schools when I
> >> did (1956-64). We received an extensive arithmetical education, both in
> >> decimal numeration and in the use of expressed fractions (i.e., the
> >> WOMBAT system of numeration). I don't know if schools are as tough today
> >> as they were then, but my elementary-school contemporaries were made to
> >> run the mathematical gauntlet of the times.
> >>
> >> Another poor prescription writing practice is the use of a trailing zero
> >> when it is not a significant digit. If the decimal point is not clearly
> >> legible, and there is a ten-fold strength of the drug available, 2.0 mg
> >> can become 20 mg. There is NO reason to write "2.0 mg"!!! "2 mg" is all
> >> that is required.
> >>
> >> A few (VERY few) prescribers write ALL of their prescriptions in grams,
> >> i.e., if there is a 1 mg dose, the order is written as 0|001, and 25 mcg
> >> is written as 0|000|025. This would be a good safeguard if everybody did
> >> it as a standard notation, but few do it, and it probably raises more
> >> questions than it answers when it appears.
> >>
> >> The best solution to this communication problem is mathematical facility
> >> in using decimals and in using SI, so the writer writes either 0.025 mg
> >> OR 25 mcg (sorry, I don't have a "mu" handy) and the reader can
> >> understand either notation.
> >>
> >> I must also confess that use of the SI "mu" prefix for "micro" can cause
> >> confusion in medication orders, since a careless writer will make the
> >> "mu" look like "m", so we have to read between the lines and/or call the
> >> prescriber to verify (time for electronic order entry in all medication
> >> orders!).
> >>
> >> --
> >> Paul Trusten, R.Ph.
> >> 3609 Caldera Boulevard, Apt. 122
> >> Midland TX 79707-2872 USA
> >> [EMAIL PROTECTED]
--
Paul Trusten, R.Ph.
3609 Caldera Boulevard, Apt. 122
Midland TX 79707-2872 USA
(915)-694-6208
[EMAIL PROTECTED]
