Quality Matters Newsletter

Medication Safety in the Medical Office (Winter 2012)


Sample medications from pharmaceutical drug representatives allow patients to try a new medication without financial implications. Despite these medications being “free-of-charge”, the liability of their use remains the responsibility of the prescribing physician. The proper handling and distribution of these “samples” is set forth in the Ohio Revised Code:

 

“Samples may be distributed from the manufacturers or representatives to a licensed

individual who has legal authority to prescribe the drug”.


Recommendations for Dispensing Medications in the Office if you choose to do so

The following recommendations are suggested to improve patient safety and reduce liability exposure.
 
 
  1. All sample medications should be located in a locked room (not in exam rooms)
    1. Schedule II drugs should be double locked
  2. Distribution of non-controlled drugs should be documented in the patient’s chart
    1. A master log is helpful if a recall is done
    2. Non-controlled drug documentation includes
      1. Medication name
      2. Dosage
      3. Number dispensed
      4. Lot number
      5. Expiration date
      6. Dispenser’s name and date
    3. Written directions are furnished if use differs from original package instructions
    4. Drug must remain in manufacturer’s original packaging
  3. Controlled substance must be documented in the patient chart as well as a separate log containing:
    1. Patient’s name
    2. Date
    3. Drug
    4. Strength
    5. Quantity
    6. Lot number/expiration date
    7. Physician dispensing medication(s)
    8. Each practice should develop a process to track and monitor (weekly-monthly) non-controlled and controlled samples use as well as lot numbers and expiration dates
  4. Don’t dispense sample medications to employees unless documented as above for patients (self medication can lead to adverse events and liability)
  5. In Ohio, samples may be given to the patient only by the prescribing physician
    1. If patients request refills of sample medications, these can only be dispensed by a provider with prescribing authority

Best practice recommendations:
 
 
  1. Sample medication distribution is documented in:
    1. Log
    2. EMR/medical record
    3. Pharmacist (if part of team)
  2. Written instructions are given to the patient (documented in chart)
  3. Medication label on sample documents:
    1. Patient name
    2. Dose
    3. Number dispensed
    4. Instructions on how to use

Injectable medications increase the risk for medical errors. The proper medication and dose are critical to quality care, yet syringes with fluids not in the appropriate containers are often found in the office setting. A recent study by The American Nurses Association reported that 28% of nurses NEVER LABEL the syringes (only 37% always did).

Recommendations for Injectable Medications in the Office

To prevent injectable medication errors the following recommendations are suggested:
 
 
  1. Label all syringes immediately after medication is removed from vial
    1. Label should include:
      1. Nurse’s name
      2. Date
      3. Time
      4. Drug
      5. Dosage
    2. Label needs to be:
      1. Legible
      2. Large enough to be read
      3. Large enough to write on
  2. Don’t rely on color coding or memory!
  3. If in doubt, discard syringe, re-fill as above!
  4. Assure medication is not outdated
  5. Record date on vial after first draw; discard per manufacturer recommendations
  6. If medications are refrigerated, daily temperature checks are recommended
    1. Refrigerator and freezer temperature logs should be kept

It is recommended that a policy and procedure be in place to ensure mechanisms for distribution, storage, education and monitoring with record keeping be in place. Document transaction with receiving physician keeping record of receipt.

Document thoroughly in the patient’s chart after dispensing or use of medications. A sample template of “Medication Refill Request”, “Medication Log”, and “Refrigerator/freezer Temperature Log” are available to MGO members on the web site.

Practice the “Six Rights”
  1. Right patient
  2. Right drug
  3. Right dose
  4. Right route
  5. Right frequency
  6. Right date

 

 

 

Disclaimer

The information and suggestions presented in PLPP Risk Management Articles and Practice Tools are to be viewed as aids to enhance patient care and safety. The intention is to be educational and is not a substitute for sound professional judgment, nor is it to be viewed as legal advice. Questions, contact MGO at 614-223-3333

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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