The day-to-day variability of blood glucose concentrations in juvenile diabetes means that it is often more reasonable to aim to achieve a generally good pattern of blood glucose control, rather than regularly to assess the next insulin dose after each blood glucose measurement. This means that immediate assessment by the patient of his blood glucose concentrations is not always necessary. We have investigated control in 22 insulin-requiring diabetic patients by means of a monthly series of four blood samples taken during a day into collector bottles and transported to a laboratory for blood glucose assay. The overall means before breakfast, before lunch, before dinner, and before bed were 6.1, 5.8, 7.3, and 7.2 mmol/L, respectively. In many patients, sufficiently good control can be obtained by this method so that it is not necessary to ask them to measure their own blood glucose concentrations or to ask them to obtain the fairly expensive meters for reading glucose oxidase strips. Control would then probably be best assessed by a series of three daily profiles taken once per month, with, if necessary, the results being discussed with the patient. On the other hand, in more unstable diabetes, home assessment by patients of blood glucose measurements is indicated.
This article explains the value of moving to a standardized national reporting program for medication errors. Early benchmarking activities related to medication errors were ineffective due to difficulties in reporting and the stigma associated with higher reporting rates. One institution's participation and experience with MedMARxSM (an Internet-accessible program for tracking and analyzing medication error reports with a link to an anonymous national database) is described, and some useful features of the program are highlighted. Ninety-five percent (95%) of the errors reported in the database did not result in patient harm, yet these records provide information that may guide efforts to reduce errors. Participation in the MedMARx program has helped our institution's medication error reporting program focus on performance improvement through more careful analysis of the causes of errors and “near misses.”
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