Tuesday, September 15, 2009

Beware of Computer-directed Lemmings

Older man with demenia falls, hits head.
Wife: "Arnie, Arnie are you all right?" Arnie just mumbles.
Heart rate slow, blood pressure low - paramedics give atropine - heart rate better, blood pressure not so. Comes to ER.

CT of head/neck done - okay. Hemoglobin 9.2
Junctional rhythm, narrow escape.
Patient confused.
Patient admitted.
Lovenox given.
Flu shot administered.

"Um, lovenox?"

"Yep, I saw the DVT alert!"

"Was there a hemorrhage alert, too?"

"Hmmm, I didn't see one..."



Anonymous said...

What, no pneumovax administered along with the Lovenox and flu?
They must have missed an alert.

nitroRN said...

Sometimes I think that we are going to be trained out of the ability to critically think. The residents that I see come through are able to write for prophylaxis, but would not be able to think of contraindications to save their lives.

On my last shift the residents in the ED attempted cardioversion on a patient with known paroxysmal afib 3 times with out so much as running coags or calling Cardiology. When they called report and asked me if I had any other questions I said no, just send him up, NOW! The patient was not anticoagulated, and I am just thankful that they were unsuccessful in their administration of electricity.

Michael Dowling said...

If we did prophylax without alerts, reminders etc. there would be no issue. If your engine oil lite didn't come on and you fried your engine you wouldn't be gloating how great it is to be free. Alerts need to be 'smarter', and we still have free will. An alert could alert you to think about contraindications if you programmed your brain to do so.

the problem i see is pharma supporting doctors writing guidelines that end up getting applied to 95 y.o.'s (eg diabetic guidelines). We need to be able to customize alerts. But they exist because we were not doing a good job. It is, I am aware, unclear how much they actually will help.