Can I use AI to craft a learning experience?
Multiverse Decision Maker
I recently discovered the vast amount of GPT’s available and was intrigued by one that may be useful in all aspects of our professional and personal lives. Enter the Multiverse Decision Maker.
Dubbed as a tool to help explore the wide variety of decisions we face everyday and evaluate the possible outcomes, I wanted to see if this applied to healthcare simulation. Healthcare providers are faced with a wide variety of daily decisions that we attempt to replicate within the safety of a simulation experience…so I reflected on a simulation lab that I facilitated that required the learner to give 2 units of insulin.
The learner actually provided 2 cc’s of insulin which lead to a different outcome and a topic that could be discussed at length. I proceeded to ask the MDM GPT the following:
A nurse is deciding between giving 2 units of insulin and 2cc's of insulin. What is the best course of action?
Disclaimer: I realize this is not a replacement to clinical education and learning and is meant as an experiment but also a proving ground to see how we can possibly leverage the AI. The results were interesting. Not only did it provided unbiased review of the situation but also important key indicators, considerations and action items.
The response is below and the GPT can be found here - https://chatgpt.com/g/g-MOUNzVaEB-multiverse-decision-maker
___________________________________________________________________________
Ah, this decision involves a critical difference in terminology and measurement that could have significant implications for patient safety. Let's break this down carefully and examine the multiverse of possibilities with precision.
🌌 Step 1: Clarify the Pivotal Factors
The key factors here are:
Dosage Accuracy: Insulin dosing must be precise to avoid severe hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).
Terminology: Insulin is typically measured in units, not in volume (e.g., milliliters or cubic centimeters). A misunderstanding between "units" and "cc" could lead to a dangerously incorrect dose.
Patient-Specific Context: The patient's prescribed dose, their insulin sensitivity, and the type of insulin in use (e.g., short-acting, long-acting) must align with the correct measurement.
🎯 Probing Questions for Clarity
To ensure we have a full picture, here are questions the nurse (or decision-maker) should consider:
What is the patient’s prescribed insulin dose?
Insulin prescriptions are typically given in units (e.g., "2 units of rapid-acting insulin before meals"). Was the prescription written in "units" or is there any ambiguity?
What type of insulin is being administered?
Different types of insulin (e.g., U-100, U-500) have different concentrations. For example:
U-100 insulin has 100 units per milliliter (1 cc).
U-500 insulin has 500 units per milliliter (1 cc).
Are the tools for administration (e.g., syringe, pen) being used correctly?
Insulin syringes are calibrated in units, not volume (cc/mL). Confusing these could lead to a dosing error.
Was the dosage verified with a second nurse or per institutional protocol?
Most hospitals have protocols for double-checking insulin doses to prevent errors.
🗺️ Multiverse of Scenarios
Here’s how the situation could play out in different universes:
Universe 1: The Nurse Administers 2 Units of Insulin
If the prescription and patient context confirm 2 units of insulin, and the nurse uses an insulin syringe (calibrated in units), the patient receives the correct dose. This is the expected and safe path if the prescription aligns.
Universe 2: The Nurse Administers 2 cc of Insulin
If the nurse interprets "2 units" as "2 cc" (or milliliters), a potentially fatal overdose could occur. For example:
U-100 insulin: 2 cc = 200 units (100x the prescribed dose!).
U-500 insulin: 2 cc = 1,000 units (a catastrophic error).
Universe 3: The Nurse Recognizes the Ambiguity
The nurse pauses and seeks clarification. They confirm that the correct dose is 2 units, not 2 cc, by:
Consulting the medication order.
Double-checking with another nurse or the prescribing physician.
Using institutional resources (e.g., pharmacy or protocols).
This choice avoids potential harm and demonstrates the nurse’s commitment to patient safety.
Universe 4: The Nurse Confirms the Dose But Misuses Equipment
The nurse knows the correct dose is 2 units but accidentally uses a tuberculin syringe (calibrated in cc/mL rather than units) instead of an insulin syringe. This could result in either an overdose or an underdose, depending on how they interpret the syringe markings.
🔮 Second- and Third-Order Effects
Safe Administration (2 Units):
The patient maintains stable blood sugar levels.
The nurse prevents adverse effects and gains confidence in their decision-making.
Overdose (2 cc):
The patient could experience severe hypoglycemia, which might lead to seizures, coma, or even death.
The nurse could face disciplinary action, a loss of confidence, or legal consequences.
Seeking Clarification:
The nurse ensures patient safety and upholds professional standards.
This proactive behavior could prevent future errors by improving team communication and protocol adherence.
🎭 Immersive Exploration: A Day in Each Universe
Imagine the nurse's experience:
Universe 1 (Safe Administration)
The nurse carefully draws up 2 units of insulin in an insulin syringe. They double-check the order, confirm the dose with a colleague, and administer the injection. The patient later reports feeling well, and their blood sugar levels remain stable.
Universe 2 (Overdose)
The nurse mistakenly draws up 2 cc of insulin and administers it. Within minutes, the patient becomes unresponsive due to dangerously low blood sugar. A rapid response team is called, and the nurse feels a sinking dread as they realize the mistake.
Universe 3 (Seeking Clarification)
The nurse notices something feels off about the order or dose and asks another nurse to confirm. Together, they clarify that "2 units" was intended, not "2 cc." The patient receives the correct dose, and the nurse feels relief knowing they took the time to double-check.
🗺️ Actionable Steps
Always Verify the Prescription:
Double-check the prescribed dose in units. If there's ambiguity, ask for clarification.
Use the Correct Equipment:
Insulin syringes are calibrated in units. Never use a tuberculin syringe or other equipment unless explicitly trained.
Follow Protocols:
Many institutions require a second nurse to verify insulin doses. This is a vital safety check.
Educate and Advocate:
Advocate for clear prescriptions and staff education to prevent similar errors in the future.
🌌 Final Guidance
The safest and best course of action is to clarify the prescription, verify the dose, and use the proper equipment. Patient safety is paramount, and taking a moment to ensure accuracy can save lives. Let this be a reminder of the power of pause and verification in healthcare.