💖Patient safety is the reason we get up every morning and work on Instinct. With every new feature, we obsess over how to enhance safety and avoid unintended consequences of technology.
When setting up Instinct for hospitals, we’re often asked why medications are written in mLs or tablets on the treatment sheet. 🤔
Here are some common questions that follow:
💊 We carry multiple formulations of the same drug, so how will we know the concentrations?
💊 What if we're used to writing treatment sheets with just mg or mg/kg?
💊 How will we track newly stocked and back-ordered formulations?
💊 How will this work when the ordering doctor doesn’t know the formulation chosen by our central pharmacy?
💊 What if our staff don’t learn how to calculate for themselves?
We get it.
With paper, many hospitals are used to writing medication orders in dose form only (ie, mg/kg or mg), leaving staff to calculate drug quantities (ie, mL, tab, cap) at the time of delivery.
But here’s the thing: Medical errors are estimated to be the #3 killer of humans in North America. On average, more people than can fill a jumbo jet die as a result of these errors every. single. day. 😲 The most common cause by far is medication errors.
Although veterinary medicine isn’t yet advanced enough in reporting (or regulation) to have this data, we likely dabble in proportional statistics.
When we built Instinct, we thought a lot about this.
We researched how and why things are done the way they are on paper, how human hospitals operate, and where errors commonly occur. After consulting our group of specialists to challenge our conclusions, we developed the standardized medication safety features in Instinct.
Before we begin, know that Instinct can be customized to write medications however you want. We are not here to tell your expert team how to keep your patients safe. However, we developed Instinct to be a gold standard for facilitating safety. Some hospitals have gone against the advice below initially, but all have eventually chosen to follow these recommendations so we're sharing these tips in one handy article.
👀 First Things First: We Actually Show It All
A common misconception when first seeing Instinct is that medications are listed differently than on your current sheets. They aren’t! We chose to standardize the way medications are written after some learning, but all ways of listing ordered medications are clearly shown: quantity to deliver to the patient (mL), dose (mg/kg), and total dose (mg).
When ordering, you can still start with any of the three based on your workflow. From there, Instinct acts like a magical safety robot calculating and listing the other values, preventing errors at the point of care.
🤏 We’re Talking About a Handful of Drugs
When you really look at it, there's only a small subset of medications where showing mL, mg, and mg/kg on a treatment sheet might raise some questions on how to accomplish that safely.
Let’s dig into some of the most common concerns we hear and how to overcome them.
💉 We Reconstitute the Same Medication in Various Ways
In some hospitals, one nurse makes up ampicillin as 100 mg/mL while others make it as 30 mg/mL.
Why are we doing that?
Reconstituting the same medication differently within the walls of one hospital, where staff, wards, pumps, and everything else is shared—not to mention hectic—is one of the most unnecessary safety risks a veterinary practice can take.
One simple best practice: Create a single standard for reconstituting medications at your organization.
💊 Sometimes We Carry Multiple Formulations
A safety expert would first ask: Do you really need multiple formulations of the same drug? Is the benefit worth the (even remote) risk of overdosing and harming a patient? Most of the time this is another safety risk we're taking for little or no reason.
Still, it may be absolutely necessary in some cases. Before hospitals adopt Instinct, products or codes are often named based on what makes sense for billing. For example, at many veterinary hospitals, there is one code for “Hydromorphone injection.”
In these (hopefully rare) situations, we recommend following human hospital best practices, where separate products and IDs are chosen for each formulation.
Now the formulation of the product will be part of the name: “Hydromorphone 2 mg/mL injection” and “Hydromorphone 10 mg/mL injection.”
🤖 Humans Are Often Better Than Robots
We couldn’t agree with this more. We named it Instinct because thoughtful automation is at the core of everything we build.
Calculation errors are an unnecessary safety risk for your patients, so while we automatically provide the calculations—and in the process, double check staff math—we still want your expert teams (humans!) to manually choose the quantity they order.
Think of Instinct as a robotic assistant—essentially your gatekeeper for medication safety. It’s uniquely built to support the hospital team, not replace them.
🅿 We Have a Central Pharmacy
This is a common concern from some of our university teaching centers with pharmacies, where ordering staff may not know the formulation being chosen.
We recommend applying safety best practices first, such as paring down drugs with multiple formulations and concentrations in the first place, and renaming products to include formulations in the name.
Beyond best practices, Instinct makes working with a central pharmacy even easier. Pharmacists can now see the treatment sheet digitally in the pharmacy in real time and modify details as needed. They can also control which medications and formulations are available for use to the clinical team in real time and centrally. Plus, Instinct offers a student (ie, draft) mode for medication ordering that requires attending clinicians or pharmacists to approve medication orders before they’re released.
🏫 We Are a Teaching Hospital and Our Staff Need to Learn
Over the ages, most new technology faced similar pushback at first.
But think about it. Would you rather take your sick loved one to a hospital with layers of double checks through the latest technology or one that uses paper simply because it’s easier for teaching? The number three killer in America…
Learning and patient safety should align, not compete.
Best practice for patient safety is that staff should always double check technology anyway, arguably creating more immediate learning feedback loops when they check against what Instinct calculated.
🆕 We Often Get New or Back-Ordered Medications
Yes, you will need to maintain these medication changes in Instinct. But we have built efficient tools that allow administrators to do this. Once they use it, our hospitals report this is easier to maintain than expected. Plus, unlike on paper, medications and formulations can be marked as newly available or out of stock/back-ordered. With this feature, your staff knows in real time what they can order for their patients.
🙌 What are the disadvantages of setting up Instinct to only show mg/kg or mg on our treatment sheets?
If you choose to list your treatment sheet medications only in mg/kg or mg, you won’t be able to access several key safety features of software.
Here’s the ever-growing list of Instinct features you’ll lose:
- Calculators with live calculation updates based on weight changes
- Time indicators for last dose given
- Patient safety warnings (over/underdose warnings)
- Plumb’s drug lookup for medications (built into our calculators)
- Billing automation, since you likely charge in mL not mg/kg
🌷 Spring Cleaning Checklist for Safety Protocols
We’ll conclude with a safety checklist for every modern veterinary hospital. We recognize that while ensuring patient safety is a top priority, it can be overwhelming to figure out where to start.
Installing Instinct is just one step and many hospitals report that it provides a great opportunity to do some safety spring cleaning using our checklist below.
✅ All drugs should have the formulation included in the label name.
✅ When naming drugs with similar names, consider using “Tall Man” lettering.
✅ Avoid carrying multiple formulations of the same drug.
✅ If you must carry multiple formulations, each formulation of the drug should have its own product ID and clear label.
✅ Standardize your drug reconstitution protocols in your hospital.
✅ Update new or back-ordered drugs centrally, and in real time.
✅ Create best practices for teams to over-document intended doses and double-check technology with manual calculations every time.
✅ Leverage technology (like Instinct) to provide decision support features such as calculators, references, overdose warnings, last dose indicators, and teaching modes to supercharge your care.