My ze high

SUNRAY said:

sadly I see a GLARING, HUGE problem with your post. ... Anyone else?

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Well, I'm certainly not beyond making "glaring, huge" mistakes in what I write (or what my typing finger s decide to type!) but, try as I may, I cannot see the issue here - but, of course, one is often totally 'blind' to one's own mistakes - so can you perhaps offer some clues?

Kind Regards, John

StephenStephen said:

One of the structural problems with maths education is that if you're successful at maths, you'll maybe go on to do maths O' levels (showing my age there!) A levels, possibly a degree and then train as a maths teacher - you therefore have little idea or understanding whatsoever what it's like not to be good at maths, what it's like not to 'get it' and may therefore be a fairly rubbish maths teacher for most people.

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Very much so.

The very person to whom you refer tried to teach me A-level and S-Level Maths. He was a brilliant mathematician, with an Oxbridge PhD, and everything mathematical was so 'obvious' to him that he simply had no conception of how/why things were not equally 'obvious' to everyone else.

A very common problem was that when he was presenting a 'proof' or series of calculations, he would move from one 'line' of the calculation to the next in what would have required several written steps on the part of most mere humans. When asked "how does equation 4 follow from equation 3?" his answer would usually be along the lines of "because it obviously does"! ... and, similarly, if a calculation culminated in a numerical result, his answer to the question "Why is the result 12345?" would, similarly, be "because it obviously is"! However, most of us managed to get reasonable grades, despite him

I think Maths is a discipline which has an extraordinarily wide range of 'abilities'. By virtue of my background/education, my mathematical knowledge and skills are probably regarded as 'amazing' by most of my family, friends and (non-mathematician) colleagues, but to an academic mathematician, the level of my knowledge and abilities undoubtedly appears 'pitiful'

Kind Regards, John

SimonH2 said:

When I look at petrol prices I'll round up the 0.1p, so (say) 115.9p/l to me is 116p/l - but to my wife it's 115p/l.

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Ah, she must have learnt that from "age" ... age is one of the few things which (probably for the obvious reason!) virtually always gets 'rounded down', even when one's next birthday is only a few minutes away

Kind Regards, John

JohnW2 said:

Furthermore, sticking with integers is much 'safer', particularly when the bit to the left of the decimal point is something other than zero, since decimal points can sometimes be overlooked, or not 'seen to be in the right place'. That is one reason why, for example, modern practice with drug doses is avoid fractions (decimal or otherwise) wherever possible - there have been occasions in the past when, say, "1.2 g" has been misread as "12 g" (or vice versa), an error much less likely to occur if the former dose is expressed as 1,200 mg.


Kind Regards, John

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That's a comment about avoiding decimal points for clarity... 1,200mg 1.200mg hand written in a hurry by a doctor in his 12th hour of duty in the middle of the night...

SUNRAY said:

That's a comment about avoiding decimal points for clarity... 1,200mg 1.200mg hand written in a hurry by a doctor in his 12th hour of duty in the middle of the night...

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Exactly - so if (as has been done) one establishes a convention of (virtually) never using decimal points, then anyone who thinks they are seeing a ('badly written') "1.200" figures knows that cannot be what was written/intended. Some people/places go further and also 'ban' the use of a comma 'thousands separator' - in which case the resulting "1200 mg" is even less open to possible misinterpretation.

I mentioned before that such conventions exist to minimise the possibility/impact of dose errors "even if they are 'stupid' or 'idiotic' " - and some of these conventions arose because there have been incidents which were stupid/idiotic! One of the saving graces (in terms of possible dose errors) about drugs it that they generally generally come in 'units' (tablets, capsules, ampoules/vials etc.) which correspond to the commonly prescribed dose(s) - which hopefully causes one to smell a rat (and hence check) if an apparently prescribed dose would require a small fraction, or large multiple, of one 'unit' (tablet, vial or whatever).

However, many years ago there was at least one case (which resulted in some of the changes in practices!) in which the 'decimal point issue' arose, and some 'stupid idiot' did not bat an eyelid about having to open up 10 vials (lucky it wasn't 100 ) of a drug in order to get the apparently-prescribed dose!

I would add that 'the worst of all' (and this has also happened, in the past, with drugs) is to write a figure with a decimal point but without a preceding zero - e.g. " .25 " which can (and has been!) easily read as "25"!

Kind Regards, John

JohnW2 said:

I would add that 'the worst of all' (and this has also happened, in the past, with drugs) is to write a figure with a decimal point but without a preceding zero - e.g. " .25 " which can (and has been!) easily read as "25"!

Kind Regards, John

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Before my time but something like that happened to a girlfriends grandmother and Morphine.

SUNRAY said:

Before my time but something like that happened to a girlfriends grandmother and Morphine.

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Yes, morphine was a classic. In days of old, there was no problem when it was prescribed as " a quarter" or "a half" (of a grain), but when the 'enlightened' started prescribing 'with numbers', handwritten ".25" and ".5" sometimes resulted in 10-fold overdoses. Similarly with digoxin, a common dose being 0.25 mg (now prescribed as 250 microg), when the handwritten " .25" could result in the same error.

In both cases, the resultant 10-fold overdose would have been likely to be fatal.

Kind Regards, John

A maths teacher at school once told us how he was on warfarin for his heart - and one time he picked up his prescription, the dose was 10x what it should have been. And I've had to deal with multiple dispensing errors at the chemist for my mother - typically putting things back in the packs that weren't supposed to be there.

That reminds me of what happened to me once when I collected a prescription from an independent pharmacy in a nearby town. I got a phone call that evening from the pharmacist who said he had been worrying all day that he had given me the wrong dosage of my medication (he hadn't). He had then gone to a lot of trouble to track me down and phone me. I just can't imagine that happening these days.

All these disadvantages would appear to be due to carelessness by people - doctors and pharmacists - who should know better so whatever method is used would not really matter.

Isn't the decimal point, when hand-written, placed at the mid-height of the number? This does not happen with the computer or printer so is more likely to be misread.

Plus, Europe and a lot of the world use the point and comma the other way round so that would not apply.

SimonH2 said:

A maths teacher at school once told us how he was on warfarin for his heart - and one time he picked up his prescription, the dose was 10x what it should have been.

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Drugs like warfarin pose a particular problem, since the range of (individually titrated) doses that may be (correctly) prescribed is fairly unusually wide. That means that, unlike the case with many/most drugs, a 10-fold error in writing or reading of a dose is not necessarily obvious, to either a human being or a computer.

Kind Regards, John

EFLImpudence said:

All these disadvantages would appear to be due to carelessness by people - doctors and pharmacists - who should know better so whatever method is used would not really matter.

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Yes, but one has to be realistic/pragmatic.

There are around 3 million items per day (i.e. around 1 billion per year) prescribed (NHS) 'in the community' in the UK, and goodness knows how many more in hospitals.

It's all very well to say that those involved "should know better" but when ('fallible') human beings are involved and the numbers (hence opportunities for errors) are so astronomical, an appreciable number of mistakes is inevitable - even an 0.001% error rate (hardly credible for anything involving human beings!) would equate to about 10,000 errors per year (any one of which could potentially have fatal consequences)! It therefore follows that everything possible must be done to minimise the possibilities of errors, and the sort of rules/practices/conventions I've been talking about are attempts to achieve that. Simply relying on people "knowing better" would really not be acceptable.

EFLImpudence said:

Isn't the decimal point, when hand-written, placed at the mid-height of the number? This does not happen with the computer or printer so is more likely to be misread.

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You're probably right, but only a decreasingly small minority of prescriptions are now handwritten.

The move to primarily computer-generated prescriptions has at least done a lot to minimise errors in writing prescriptions. Computerised systems will usually not allow prescribing of mis-spelled drug names or 'impossible' doses, and will quiz the user extensively if an 'unusual' dose is prescribed. When there are other medicines with similar names (traditionally a fairly common cause of errors) they will usually ask for confirmation, and some systems will also query a situation in which the same patient has previously been prescribed a drug with a similar (but different) name and/or the same drug at a different dose. It will also warn about incompatible combinations of medicines and/or 'warnings/cautions' relevant to the prescribing of particular medicine.

However, dispensing almost always involves human beings, who therefore have to correctly read what has been prescribed (and there your point about the positioning of a printed decimal point may be relevant). I think that the most sophisticated systems involve scanning of the barcode of what is to be dispensed (all medicines now have to be dispensed in their 'original packaging'), and comparing that with the prescription (if electronic) - whilst that would prevent most errors, I don't know how widely implemented it is.

Kind Regards, John

One of mum's prescription errors was computer created - and I took it up with the pharmacists body. Unfortunately they can't do much other than with the pharmacist. In this case, their omputer keeps a list of what's been prescribed, the prescription comes in, and a human has to notice that there's been a change. So a human has to notice that an item has been dropped, and untick the box to put that item in the packs - the pharmacist showed me their system. Now there's a system designed to cause errors - instead of having the computer cross check and alert the fallible humans.

Edit: not sure where you get the "original ackaging" bit from. Yes tablets are still in he factory blister strips, but they still get transferred to plain white boxes with a pharmacy label.

SimonH2 said:

One of mum's prescription errors was computer created - and I took it up with the pharmacists body. Unfortunately they can't do much other than with the pharmacist. In this case, their omputer keeps a list of what's been prescribed, the prescription comes in, and a human has to notice that there's been a change. So a human has to notice that an item has been dropped, and untick the box to put that item in the packs - the pharmacist showed me their system. Now there's a system designed to cause errors - instead of having the computer cross check and alert the fallible humans.

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There are a variety of computer systems used by pharmacies and, although I'm not sure that I fully understand the error you are describing, it sounds as if it was, to say the least, a less-than-ideal system that was being used. However, I am much lessd familiar with systems used for dispensing than those used for prescribing, so I don't know 'how good' the former generally are.

I am sure that the move to computer-based prescribing must have been very beneficial, since a high proportion of errors used to relate to poor handwriting/spelling or errors or incorrect recall or beliefs about appropriate dosage, but you raise an important point. When one moves to a computer-based system (whether for prescribing or dispensing), it is crucial that it is a 'pretty good' system, since users will become reliant on (and trusting of) it, and hence potentially complacent in letting down their guard in relation to the 'human checking' that they would previously have undertaken..

SimonH2 said:

Edit: not sure where you get the "original ackaging" bit from. Yes tablets are still in he factory blister strips, but they still get transferred to plain white boxes with a pharmacy label.

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I obviously have to take your word for that, but it does rather surprise me. Well before the turn of the century, at least half the community dispensing was on the basis of "Original Pack Dispensing" (OPD). At that time there was a strong lobby to make it OPD more-or-less universal (with a few necessary exceptions), probably 'mandatory', and I had assumed that would have happened by now. It is certainly the case that neither I nor any of my family members have received any dispensed medicines in the past 20+ years other than on an 'OPD' basis.

I'm not really sure why a pharmacist would normally do as you describe. Because OPD is so ubiquitous, very few medicines are any longer supplied 'in bulk' (even to hospital pharmacies). Quite apart from the 'unnecessary effort' of what you describe is the fact that there is a requirement to supply a "Patient Information Leaflet" with any dispensed medicine. Since there will be only one such leaflet in any 'original pack', if less than the entire contents are transferred to a 'plain white box', the remainder of the contents would probably end up having to be destroyed.

Until a few days ago, there was another issue. Although I confess that I'm not sure whether this always happened in practice, as I understand it the EU "Falsified Medicines Directive" theoretically required a 'tamper resistant seal' to remain (intact) on the original pack up utill and when it was supplied to a patient - something which would obviously be impossible (with the original seal) if the contents had been transferred. However, I believe that Directive has 'ceased to apply' in the UK since the Brexit transition period ended at the end of 2020 and I don't know what, if any, UK legislation is planned to replace it. It seems that some plans have been made for NI, but things are much more hazy as regards GB! ...

HM Government said:

1 January 2021 update
The Northern Ireland Protocol came into effect from 1 January 2021 and will result in changes to regulations regarding medicines in relation to importation requirements and compliance with Falsified Medicines Directive.
There will be a twelve-month phased in approach of these regulations. This is to ensure there is no immediate impact on the supply of medicines following the transition period.
Further information will be provided in the coming weeks, alongside additional guidance outlining the implications for the Great Britain market. Until this new information is provided, the content below may not be accurate. ......

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Kind Regards, John

Well a prescription I picked up recently was for 84 tablets. The tablets come in blister sheets of 10 from this particular vendor - IIRC different makes have come in different sized sheets. So I got a white box with 8 full sheets, and 4 cut from another sheet.
In the past I've had similar dispensing, but where the (e.g.) "100 tablets" on the printed box is crossed out and 84 written next to it.

The tablets themselves are all in sealed blisters - so not the same as having 84 loose tablets put into a bottle.


As to the error I was describing, it was almost like having two systems even though they were in the same software package. One shows the prescriptions that have come in, the other shows the pharmacy record of what the patient gets. I.e., information from the GP does not update the pharmacy records. So when the prescribed medication changes, the pharmacist has to see that there's a change and transfer that change from one system to the other - there may be a process that handles this.

The "missing link" is that the computer should be able to compare the two and highlight when (as in my mum's case) the prescription doesn't include something the pharmacy record says it is going to dispense.