Because, in doing so, Jerry, I would be flying in the face of their peers, who are not concerned with ordering in metric units only.
The people we want to reach on prescribing in the metric system are the medical educators (e.g., the ones who taught Remek Kocz to use fluid ounces), and, most importantly, the standards-setters, such as the Joint Commission, the Institute for Safe Medication Practices (ISMP). We already have ISMP solidly in our corner. I think the JC will follow, but that may take a while. Quoting Jeremiah MacGregor <[email protected]>: > Even if all pharmacy people understand both systems don't you think it is in > your best interest to push for just one system? What harm would be done if > you used a little pressure on those reluctant prescribers? > > Jerry > > > > > ________________________________ > From: "Paul Trusten, R.Ph.." <[email protected]> > To: U.S. Metric Association <[email protected]> > Cc: U.S. Metric Association <[email protected]> > Sent: Sunday, February 22, 2009 2:25:23 PM > Subject: [USMA:43210] Re: prescribing medications > > > Quoting Jeremiah MacGregor <[email protected]>: > > > If a prescriber requests an ounce amount would you ever consider contacting > > him/her to clarify the amount in metric based on 5 mL incremental doses? > > Would you ever tell him/her that you don't do ounces as they were > > decommissioned in 1995 and may be considered illegal? > > No. All pharmacy people understand the units in both systems. Trust me that > there are so many rules surrounding prescriptions that they cannot all be > enforced. Even though the USP has eliminated the official use of apothecary > units, you won't see anyone being officially disciplined for using them. They > remain institutionalized in practice. > > > > Do all suppliers use 473 mL stock bottles or are there some that may use > 500 > > mL. If that be the case, then buy only from companies that use the 500 mL > > size and tell the ones that don't that you will not buy their products > until > > they do. > > Often times, there is no choice, and it would be impractical to order only > metric products. The medications must be in stock. > > However if you are providing increments of 5 mL doses, wouldn't you > > want the stock container to have slightly more then 500 mL to assure that > > even the last dose gets the right amount as there is always some product > that > > will stick to the bottle and thus there is some wastage? > > There is always a small amount of wastage. Common sense rules. > > > > > > Jerry > > > > > > > > > > ________________________________ > > From: Paul Trusten <[email protected]> > > To: U.S. Metric Association <[email protected]> > > Sent: Sunday, February 22, 2009 10:22:23 AM > > Subject: [USMA:43199] prescribing medications > > > > > > List subscribers, I apologize for the length of this post, but Remek has > > asked, and I wish to deliver. Others may find it interesting, too. > > > > Dr. Kocz, for the first time in my 33-year pharmacy career, I have a chance > > of nibbing this one in the bud--you go right ahead and prescribe in > > milliliters! All pharmacists will understand you exactly. Nothing is > > stopping you from doing so, and this pharmacist/metricationist would be the > > most pleased in the world. And, in the U.S., the apothecary system was > > officially decommissioned by the United States Pharmacopoiea in 1995. That > > doesn't mean most prescribers haven't ignored or not heard that fact and > > continued to write their fluid ounces, but certainly there is no rule > against > > ordering oral liquid medication in milliliters and writing directions in > > milliliter doses. In fact, by writing the dose in milliliters, and also, > > please if possible, its equivalent in milligrams, you are ensuring that the > > patient will get the correct dose. > > > > A 120 mL portion often gets poured from a larger stock bottle, but that > > volume is no rule; it is only habit. If you want, order 150 mL; order 200 > > mL. We measure it and pour it into a dispensing bottle. It all depends upon > > how much medication you want the patient to have. You are constrained only > > by the limits of the law, e.g., usually only a 30-days' supply for a > > so-called "controlled substance" medication (narcotic or similar) > > > > Let's say the directions are for the patient to take 5 mL by mouth four > times > > a day (or, every six hours). So, your "standard" 120 mL order turns into a > > six-day supply of medication. If a five-day supply is what you prefer, you > > could go an even 100 mL. You are the prescriber; it is your decision. We > > measure the out and dispense the volume you order. The dispensing bottles > (at > > least in the U.S.) are even calibrated in both fluid ounces and > milliliters, > > and, I would think that, in other countries, they have a milliliter scale > > only. If they don't have any scales, we use a conical graduate (a graduated > > glass pharmaceutical beaker) to measure the liquid accurately. > > > > Now, granted, some oral liquids are marketed in those pesky 120 mL stock > > bottles. Well, we are going to end up with a partial bottle if you order > only > > 100 mL, but that's our problem, and if we have to,we might call you to ask > to > > adjust the quantity if it's that urgent. > > > > Here's a typical situation: Tussionex, a potent narcotic antitussive > (cough) > > syrup (if you've ever had bronchitis, you've looked forward to benefitting > > from the quieting effects of this drug product)--is dosed 5 mL by mouth > > twice a day. That's 10 mL per day. Your patient might need a 10-day supply, > > so there is your 100 mL prescription order. We pour it out of a 473 mL > stock > > bottle. Why stock bottles of controlled substances are not marketed in > round > > metric sizes is still beyond me. It just makes it that much harder > > foreveryone to inventory--manufacturers, wholesalers, and dispensing > > pharmacists, and inventory these products we must--as often as every week, > > depending upon pharmacy policy. U.S. Federal law requires a physical > > inventory of the stock of all controlled substances in a given > pharmacy every > > two years. > > > > > > > > On the public side, the problem is that, once you write "5 mL p.o. tid" > > (meaning, take 5 mL by mouth 3 times a day), you are running up against a > > public, at least here in the U.S.. which, I believe, doesn't know what you > > are talking about yet when you say "5 mL." It isn't part of the language > yet; > > the teaspoonful is, still. The U.S. has not yet laid down in its > healthcare > > culture a milliliter-only medicine spoon. Oh, yes, we have plastic spoons > > available at pharmacies from time to time, but there has not yet been > > established the routine practice of supplying one with the dispensing > of each > > prescription oral liquid medication. I hope to see the day that safety > will > > mandate both metric-only prescribing and metric-only measuring for oral > > liquid medications. > > > > Incidentally, the Institute for Safe Medication Practices (ISMP), an > > important U.S. authority on the safe use of medication, recommends that > only > > the metric system be used in prescribing. I could have recommended that > > myself when I first confronted the issue as a pharmacy student in 1974. > > > > Thanks for your patience in reading this lengthy post. > > > > Paul > > ----- Original Message ----- > > From: Remek Kocz > > To: U.S. Metric Association > > Cc: U.S.. Metric Association > > Sent: 21 February, 2009 18:59 > > Subject: [USMA:43175] Medication sizes. > > This question goes out mainly to our very own Paul Trusten, but anyone can > > join in. I'm at the stage of my medical education where we've been taught > to > > write prescriptions, and I see that dosages are typically metric, with an > > occasional teaspoon thrown in by one of the old-school doctors. However, > > many liquid med bottle sizes are given in fl oz. On a number of occasions > > I've been directed to write "Disp 4 fl. oz." on the second line of the > > prescription many times. The question naturally is, what's the real > > dispensed size of the bottle? In the future, when I'll do this on my own, > > can I just put down "Disp 120 mL"? > > > > Remek > > > > Paul Trusten, R.Ph. > > Public Relations Director > > U.S. Metric Association, Inc. > > www.metric.org > > 3609 Caldera Blvd. Apt. 122 > > Midland TX 79707-2872 US > > +1(432)528-7724 > > [email protected] > > > > > > > > > > > -- > > > > Paul Trusten, R.Ph. > Public Relations Director > U.S. Metric Association (USMA), Inc. > www.metric.org > 3609 Caldera Boulevard, Apartment 122 > Midland TX 79707-2872 US > +1(432)528-7724 > mailto:[email protected] > > > -- Paul Trusten, R.Ph. Public Relations Director U.S. Metric Association (USMA), Inc. www.metric.org 3609 Caldera Boulevard, Apartment 122 Midland TX 79707-2872 US +1(432)528-7724 mailto:[email protected]
