A Factor of 10 - ReluctantPatient Posted: Mar 7th, 2016 - 2:42 pm In Reply to: WE CAN SAVE YOU 6 CENTS PER LINE! - Old Hippie
I have another opinion about this story. I'm a terrific transcriptionist, but I guarantee you I have on occasion typed 50 instead of 15 and maybe even 80 instead of 8 -- VR or staight typing. And I'm not going to blame this on trying to make a production quota; I will attribute it to being fully human.
Physician orders should have never been dictated. Back in the day, the provider had preprinted forms. Sometimes the patient received standard orders, and if the standard orders were to be changed in some way the doctor would note that and initial it. I remember tracking physicians down to verify their orders. Now we have EMRs. The provider should enter orders directly into the system. Then the liability is on the physician, and there is less chance of a mistake.
What is truly concerning about this case, however, is the nurse who administered the insulin. Again, back in the day, our nurses would meet face-to-face at the shift change, and they would discuss each patient individually. Yes, they weren't doctors, but they would definitely know if the patient should receive 8 or 80 units of insulin. I think a savvy nurse from the 1990s who knew her patients would have questioned the physician about 80 units of insulin. Physicians have always made mistakes with their orders (think about it -- poor handwriting is a doctor trope). MTs aren't the only folks who make mistakes when they are in a hurry.
The nurse who administered 80 units of insulin without a second thought may be covered legally, but probably could use some continuing ed. It's not just MTs who are under extreme time restraints -- physicians, nurses, etc. are like most of us -- they don't have much time to think, which considering the jobs they do is tragic. Medical providers are becoming mindless functionaries. I think the biggest lesson here is if you're the patient in a hospital you should have someone with you to question everything that is done for and to you.
And yes, I remember those nurses who used to second guess doctors aggressively. They were usually rather annoying, but very efficient. Direct-care providers are too busy filling in forms to actually think much about their patients these days.
It's all rather sad.
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