Avoiding Medication Errors in a Medical Office

Definition of a medication error:
Medication error is an avoidable mistake in the administration of a medication. The error can produce, or start the action of, harm to a patient whiles the medication. Medication errors are a common cause of malpractice claims against physicians. Factors that can play a role in medication errors are: not knowing about patients' allergies, other medicines they are taking, previous diagnoses, and lab results; poor handwriting on the part of the prescribing person, confusion between drugs similar names; misuse of zeroes and decimal points; using inappropriate abbreviations; interruptions when preparing medicines; unclear verbal orders; and failure to follow policies.

How medication errors can be avoided:
1. Always clarify an order if not readable, not a correct dosage, not a correct route.
2. Check the 5 rights of medication administration when administrating medication. Clarify orders if there is any question about the order; never assume it is correct just because a physician wrote the order.
3. Check with the formulary on alike or sound drugs.
4. Provide both the generic and brand name in communications of drug orders.
5. Write the purpose for the medication on the prescription.
6. Provide patients with documentation about their medications.
7. Write in block letters, using upper-case (not cursive).
8. Avoid use of abbreviations and Latin directions for use (e.g., q.i.d., b.i.d.), and instead write it out, e.g., four times a day, twice a day.
9. Use a leading zero if a number is less than one (0.1), and don't use a trailing zero after a decimal (5.0).
10. Prescriptions should include: date, drug name, dosage, route of administration, frequency of administration, and signature and professional designation of authorized prescriber.
11. PRN orders should indicate a specific time interval.
12. Orders written by medical students (including sub-interns) should be countersigned by an authorized prescriber.
13. Include all known patient allergies in admission and transfer orders. The designation "no known allergies" should be used as appropriate.
14. Use only approved abbreviations.
15. Follow institution approved medication protocols.
16. Medication orders sheets should have the patient's name and other identification such as patient ID #, date of birth.
17. Orders for medication should include: date and time ordered, drug name, dosage, route of administration, frequency of administration.
18. An existing order may not be corrected, altered added to, or modified in any way. If change is necessary, the order must be discontinued and a new order written by the authorized prescriber. When discontinuing a medication, the prescriber should write the name of the drug being discontinued and not an order number.
19. The registered nurse (RN) is responsible for checking orders transcribed by a non-RN for accuracy. The RN initials or countersigns the signature of the non-RN transcribing the order as part of the verification for accuracy.


Contributed with permission by author:
LEIGH ANN TOVAR, Nursing Student (LPN)
UniversalClass.com Student: Basic Concepts of Pharmacology

Avoiding Medication Errors--Make it Your Own Personal Goal

The Internet is a powerful media. Newly published articles about medication errors serves as a vehicle to build renewed and additional awareness that more than one third of the medication errors that occur in the US involves patients 65 years, and older! I had already written about this issue in 2003 to promote awareness, and call for greater care among medical assistants, who dispense medications to patients in the medical office, or a clinic where they work.

I said it then, and I say it again: when it comes to medical assistants dispensing and administering medications in the medical office, they don't have to be nervous about it, but MUST be properly trained, and know the rules and laws to do so. They must stay within their professional scope of parctice, and be responsible, and fully accountable every step of the way.

However, not only proper training, and supervision by a licensed physician, but also awareness of why medication errors happen seems to be the key to implement medication safety, and proper patient care. The most common causes of medication errors are:

1. When medications are prescribed, such as ordering medications that are contraindicated, antagonistic, or the wrong dose.

2. When medications are dispensed, such as pouring the wrong dose, or wrong drug.

3. When filing errors occur, such as pulling the wrong file, using the wrong patient's chart during the office visit, loosing, or misfiling a report.

4. When laboratory work is ordered, such as not requesting needed lab tests, making mistakes on the lab requisition slip, failing to notice that the lab performed wrong test, missing errors, or not reporting abnormal values promptly.

5. Errors in communicating with patients, such as not explaining how to take medications, or failing to make sure the patient understood all instructions.

6. Errors in communicating with other healthcare providers in different settings, especially when hospital referral, and discharge letters are not sent, or remain unfiled.


REMEMBER: these are only the most common causes for medication errors, and there is no single cause for the problem--and no single solution either. It is very important that every healthcare provider, doctor, pharmacist, nurse, and medical assistant realizes the importance of medication error detection, reporting, evaluation, and prevention, and each working professional makes preventing errors their own personal goal!

If you have any comments, please do not hesitate to post them here!


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A Word of Caution Before Signing up For Distance Education and Training

Distance education and online training over the Internet fills a vital gap in the education field for non-traditional students, and provides e-learners with convenience, flexibility, and the ability to study anywhere, any time without being on campus. The majority of the students that seek training through virtual schools online are around 35 years old, work at full-time jobs, and two-thirds have family responsibilities. Important is to realize that online programs are not always accredited or legit.

Internet Scams
The Internet is known for many different types of scams. Sometimes, if not careful, the certificate or diploma distance education learners receive is not even worth the paper it is printed on and the time and money invested was wasted. Online training providers, non-traditional universities, and colleges who offer virtual and distance learning programs have different accreditation standards. It is important to recognize the difference between legitimate and fully accredited vs. illegitimate and non-accredited correspondence schools before signing up for any distance education courses or programs.

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Finding Employment after Externship

In Yahoo! Health Groups for Medical Assistant Students and Graduates
a member wrote:

> Getting a little anxious about finding employment after externship?
> When I signed up for this (medical assisting vocational training) program,
> there was a list of all the jobs I'd be "qualified" for: medical technologist,
> pharmacy tech, among others.
> Well, I have yet to see an ad for a pharmacy tech that
> doesn’t require a graduate of a pharmacy tech program (not MA)
> unless you want to work for a grocery store pharmacy for 7.00
> an hour. Same for the medical tech, this program just doesn't
> seem to qualify me for what they said it would....

===============================================

Having been a student once myself, and having been in the same position, having heard similar promises, having seen similar lists at my school, and having read similar wanted ads in our local newspapers, I can relate very well to this medical assisting student's fears and concerns. I don't think that there is something wrong with those feelings, neither do I think, that there is something wrong with the list of other related job opportunities that were posted at the school. I do believe, however, that there probably is a miscommunication, misunderstanding, or misconception about HOW medical assistants can get into these related allied health position once they graduated and joined the job market.

In looking back over the years, based on what I along with my fellow classmates went through, what I have experienced as a medical assisting instructor, and what I have learned through my online work, I realize now, that there always seems to come a point in every MA student's life, where they suddenly realize, that the initial excitement of learning their new skill is wearing off, and reality suddenly hits. Interestingly, one can almost predict this point precisely. It usually happens around three months prior to starting the externship, and then once again upon graduation. Part of these student's worry is the realization that once the course ends they will have to leave the security of the classroom and do something about their career. They dread the thought of having to be "out there" in this big ugly world competing with others in the field grasping every opportunity to climb the ladder of success, whether it is in medical assisting or a related field. This truly can be a frightening and troublesome thought to some, especially if they have to also consider the people around them, their expectations of them, and the heap of student loans that then must be paid back.

However, medical assistant students should not be troubled, nor discouraged. They are indeed entering into a highly rewarding field with MANY MANY opportunities. Those who are serious about their career, and remain focused on their goals will succeed, and only those who get overly frustrated and give up as a result will fail. It's survival of the fittest, not only in the medical assisting field, but everywhere. Everybody wants to get ahead, land more rewarding positions, and take home more pay! It is a given, that new graduates without experience on the job can forget to be hired into closely related, better paying positions advertised in the newspaper right from the start. The better paying jobs, and the willingness of employers hiring a medical assistant into a related, but different job must be earned. It is, however, possible!

One proven way for medical assistants to land jobs in a related allied health positions, such as becoming a medical secretary, medical records technician, medical data assistant, medical billing and coding clerk, medical transcriptionist, phlebotomist, pharmacy aides and technicians, physical therapist assistants, ophthalmology assistant, Licenced Practical Nurse (or LVN), hemodialysis/dialysis technician, nursing assistant, surgical assistant, medical laboratory technologist or technician, medical translator, medical illustrator, scientific writers, military medics, veterinary assistant, dental assistant, EMT, or whatever the goal is, is by actively seeking out avenues of expansion through additional training, taking on higher responsibilities on the job, and continued leaning and education.

Medical assistants whose goal it is to transition into other allied health and medical care related postitions must start by developing a career plan, and refining career goals early on in the game, and then follow through by demonstrating that they are serious about their career. Undoubtedly they must seek every opportunity to learn additional skills, and make many necessary adjustments throughout the course of their working career. They must remain focused, flexible, interested in taking on responsibilities in all areas and skills, especially in those areas that will look good on their work history, that they can put into their resume, and that will give them something they can take with them when they change jobs.

Through hard work, pursuing learning goals, becoming certified, continuing education, and maintaining professional relationships medical assistants can pave their way to transition or cross over into those related other health care jobs that the school has posted, and are advertised in the newspaper. If you are a medical assistant reading this, chances are it is something you already knew! Please feel free to comment.


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