<p>Oh! I'm sorry I misunderstood.</p>
<p>I am kind of in a hurry. I'm ready to be done with school and out on my own. I won't be done with my undergrad probably for a few more years and by then I'll be 24. So no time to waste.</p>
<p>So I may apply to PA school without experience and if I'm not accepted then do what you're suggesting. Or look into doing the CNA part-time for a year. I won't exceed standards, but it will work.</p>
<p>Medicine is moving rapidly away from permitting people to calculate doses in their heads. This has lead to so many medication errors that most hospital have, or are installing, systems that take the inputs (desired dose by weight, age, metabolic function, lab test- whatever) and the patient's measurements, and calculate the dose automatically. Then the calculation itself is recorded, and easy to check. At that point it is helpful if the doc has some ballpark idea of what the dose should be in case of a data entry error, but soon you will not be allowed to calculate doses while jogging down the hall and expect anyone to actually give that to a patient.</p>
<p>In any case, this is all elementary school math, which I assume you can do. Most doctors can forget the math they learned after 8th grade and be fine.</p>
<p>
[quote]
Medicine is moving rapidly away from permitting people to calculate doses in their heads. This has lead to so many medication errors that most hospital have, or are installing, systems that take the inputs (desired dose by weight, age, metabolic function, lab test- whatever) and the patient's measurements, and calculate the dose automatically. Then the calculation itself is recorded, and easy to check. At that point it is helpful if the doc has some ballpark idea of what the dose should be in case of a data entry error, but soon you will not be allowed to calculate doses while jogging down the hall and expect anyone to actually give that to a patient.</p>
<p>In any case, this is all elementary school math, which I assume you can do. Most doctors can forget the math they learned after 8th grade and be fine.
[/quote]
</p>
<p>This is true, but necessitates that a hospital has moved to electronic records and order sets...something that is not happening very quickly in most places. I've worked at several different hospitals, all on different points of the continuum and none are at this point yet. Even at the VA where orders must be put into the computer by the physician, calculated dosing is not happening (and for some reason, they can track all the vitals on the computer except I/O's - frustrating...). The University hospital is transitioning to computers by departments, but is still mainly paper. The community hospital I did surg at was the most efficient, but all the doctors orders were still done on paper charts, and then the nurses entered them into the computer system...</p>
<p>A lot of this responsibility is falling on pharmacists at the moment.</p>
<p>
[quote]
Medicine is moving rapidly away from permitting people to calculate doses in their heads. This has lead to so many medication errors that most hospital have, or are installing, systems that take the inputs (desired dose by weight, age, metabolic function, lab test- whatever) and the patient's measurements, and calculate the dose automatically. Then the calculation itself is recorded, and easy to check. At that point it is helpful if the doc has some ballpark idea of what the dose should be in case of a data entry error, but soon you will not be allowed to calculate doses while jogging down the hall and expect anyone to actually give that to a patient.
[/quote]
</p>
<p>Computer systems are useful as safety mechanisms to verify human calculations, but they in no way remove responsibility from the physician, pharmacist, pharmacy tech and nurse for personally verifying the appropriateness of any drug dose given.</p>
<p>Since all computer systems depend on the integrity of the data given, faulty data input results in inappropriate (but correctly calculated) data output -- GIGO, garbage in, garbage out. A very common data error is entering pounds instead of kilograms.</p>
<p>The narrow therapeutic index of many drugs makes careful calculation of drug dosage a necessity for safe practice. A "ballpark" idea of dosing is inadequate.</p>
<p>Interesting!</p>
<p>The "ballpark" is what you use to check the calculated dose. </p>
<p>The data entry errors are the reason (the only reason) that the calculated dose could be wrong. If you have no idea what the calculated dose should have been, then you can't check it. If you are really going to do a precise calculation, you should write it down in the chart, like anything else important in medicine. Medicine is moving strongly against doctors doing these things in their heads. The evidence against it for patient safety is overwhelming.</p>
<p>There are major pushes to eliminate paper and manual calculations in medical care, replacing them with electronic records and automated systems.</p>
<p>If you are a premed now, then automated dose calculation will be universal by the time you are practicing.</p>
<p>From the Institute for Safe Medication Practices report on pharmacy computer systems:</p>
<p>
[quote]
Our 2005 field test results clearly show that, with few exceptions, little improvement has occurred during the past 6 years with pharmacy computer systems to safeguard against medication errors. Alarming findings from our 1999 field test demonstrated that pharmacy computer systems in this country were vastly unreliable when used to detect and correct prescription errors or pharmacy order entry errors (see the February 10, 1999 issue). And now, 6 years later, we must draw the same conclusion, especially since our experience during recent consults in healthcare organizations confirms the results of the 2005 field test.
[/quote]
<a href="http://www.ismp.org/Newsletters/acutecare/articles/20050825.asp?ptr=y%5B/url%5D">http://www.ismp.org/Newsletters/acutecare/articles/20050825.asp?ptr=y</a></p>
<p>Exactly. That is why new systems are coming in. From this report</p>
<p>
[quote]
Failure to update technology may be one explanation for the general lack of improvement in pharmacy computer systems between 1999 and 2005. More than half (56%) of the participants in our field test were currently using a pharmacy system that was at least 5 years old, with no recent upgrades. In fact, 38% had been using the same pharmacy computer system for 8 years or more without upgrades. Newer pharmacy system technology (replacement or upgrades) might have yielded different results.
[/quote]
</p>
<p>and</p>
<p>
[quote]
These findings suggest that perhaps hospitals should prioritize the upgrade and replacement of outdated pharmacy systems. Improved pharmacy technology could help to reduce the risk of serious patient harm from medication errors.
[/quote]
</p>
<p>FYI concerning doctors calculating medication doses. This is as simple as a calculation can get. The error described here frequently causes heart attacks and death when it occurs in real life.</p>
<p>From the Annals of Internal Medicine</p>
<p>The Effect of Drug Concentration Expression on Epinephrine Dosing Errors
A Randomized Trial
right arrow Daniel W. Wheeler, PhD; Joseph J. Carter, MBChB; Louise J. Murray; Beverley A. Degnan, PhD; Colin P. Dunling, BSc; Raymond Salvador, PhD; David K. Menon, MD, PhD; and Arun K. Gupta, PhD</p>
<p>1 January 2008 | Volume 148 Issue 1 | Pages 11-14</p>
<p>Background: The expression of drug concentration as a ratio may cause dosing errors.</p>
<p>Objective: To examine the effect of ratio expressions on drug administration.</p>
<p>Design: Randomized, blinded, controlled study.</p>
<p>Setting: Simulation center in an urban hospital.</p>
<p>Participants: 28 physicians.</p>
<p>Intervention: Participants managed a simulated pediatric acute anaphylaxis scenario by using epinephrine ampules labeled with mass concentration (1 mg in 1 mL) or a ratio (1 mL of a 1:1000 solution).</p>
<p>Measurements: The amount of epinephrine given and the time taken to administer it.</p>
<p>Results: Compared with providers using ampules with mass concentration labels, those using ratio labels gave more epinephrine (adjusted mean dose, 213 µg above target [95% CI, 76.4 to 350.1 µg]; P = 0.003), and took longer to do so (adjusted mean delay, 91 seconds, [CI, 61.0 to 122.1 seconds]; P ≤ 0.0001).</p>
<p>Limitations: Performance in simulated scenarios may not reflect clinical practice. In reality, ampule labels provide both expressions of concentration.</p>
<p>Conclusion: The use of ratios to express drug concentration may be a source of drug administration error. Patient safety might be improved by expressing drug concentrations exclusively as mass concentration.</p>
<p>
[quote]
Rockville, Md., Dec. 20, 2004 The United States Pharmacopeia (USP) reported today that despite the perception that technology is the panacea that will improve patient safety and reduce medication errors, nearly 20 percent of hospital and health system medication errors reported to USPs MEDMARX SM program in 2003 involved computerization or automation. However, facilities that have implemented computerized prescriber order entry (CPOE) reported fewer harmful errors. According to the 2003 data, automated dispensing devices (ADDs) were implicated in almost 9,000 medication error events with 1.3 percent of those errors leading to patient harm.
[/quote]
</p>
<p>Computer</a> Entry a Leading Cause of Medication Errors in U.S. Health Systems</p>
<p>Current pharmacy order systems are inadequate to prevent errors. Perhaps future systems will be more effective. Doctors do miscalculate doses and must, until the advent of foolproof systems, maintain competent mathematical skills.</p>
<p>JennieAS: You will have to use math in your year of college chemistry and physics classes and some math on the MCAT as well. </p>
<p>You don't need a year of calculus for most med schools in the U.S., just one semester. Only a couple require a full year.</p>
<p>I agree that any fashion major would not be a good choice for applying to med school or PA school.</p>
<p>Thanks bookiemom! I've decided to stick with my Biology major instead of switching to Psychology or something along those lines, since the Bio major pretty much takes care of pre-req courses for PA school. I appreciate your reply!</p>