In the commercial, three guys are standing around a grill, talking about baseball. One of them quotes a stat. Another one says, "Really? Are you sure?" The first guy says, "I'm 99.9 percent sure." The third guy says, "Then you don't know."
I don't remember what product was advertised. I remember the commercial because the question of certainty recently came up regarding a chemotherapy order.
I was completing the chemotherapy checklist, first reviewing the orders: Patient name and identifiers: Check. Orders are dated with today's date: Check. The chemotherapy ordered is appropriate for the patient's diagnosis: Check. The dosage is correct: Uh oh, wait a minute. The total dose (in milligrams) did not equal the product of milligrams times meter squared (m2). The reason was easy to spot, however.
The chemotherapy infusion was to be administered via a CADD Prism pump over two days. The practitioner wrote:
xxxx mg of chemo drug X m2 = xxxx mg X 48 hours = total dose of chemo drug
The practitioner meant to write:
xxxx mg of chemo drug X m2/every 24 hours = xxxx mg X 48 hours = total dose of chemo drug
I was 99.9 percent sure, which means I wasn't certain. Unlike quoting baseball stats, there is no room for uncertainty in chemotherapy administration. Interestingly, the home infusion pharmacist apparently felt 99.9 percent certainty was good enough to go ahead and mix the cassette sitting in its bag in front of me. To be fair, this was not the patient's first infusion.
The pharmacist mixed the chemo based on past orders. Using a previous record to predict a result in the future is the definition of betting, which works in baseball, but not so much when administering chemo.
I called the oncology office where the order originated. The nurse on the other end of the phone pulled up a copy of the order. "Oh, the practitioner meant to write every 24 hours. If I write that and fax it back to you, will that work?"
"Are you certain?" I asked.
"I'm 99.9 percent sure."
"Certain enough to sign your name to a verbal order?" I asked. There was a pause, and she said, "I'll have an oncologist take a look, sign it, and fax it back to you."
I thanked her.
I'm not sure the patient fully understood my explanation why hooking her up to the pump was delayed, because she knew the cassette had been delivered. I explained as best I could.
More than an hour later, the corrected order, signed by an oncologist, arrived on the fax machine. We completed the double check, and started the infusion pump. The patient went home.
I was 100 percent certain the infusion was correct.
Have you had similar experiences? What's your opinion? Would you trust your familiarity with a patient's past orders and proceed with the infusion? Does your work environment support nurses delaying treatment while verifying orders?
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