Tuesday, October 10, 2006

Giving Sample Medication | A Source of Medical Error

Medication samples given to patients in medical offices is common thing in this country. This endeavor is very helpful to patients who do not have prescription coverage.

Medical errors can easily be committed in the process of giving patients drug samples. There are many areas that that mistakes can occur:

  • The sample medication has already expired but it has not been discarded for whatever the reason.
  • Wrong strength of the sample medication is given when it contains a combination of 2 medications.. For example, AtacandHCT(16/12.5) is ordered but the staff gives Atacand(16mg.) instead. AtacandHCT(16/12.5) contains 2 medications: Atacand (16 mg.) and hydrochlorthiazide (12.5 mg.)
  • Wrong strength of the sample medication is given even when it is a single medication. For example, Atacand(32mg.) is ordered but the staff gives Atacand(16mg.) instead.
  • The wrong sample medication is given to patient outright.
  • The wrong quantity of sample medication is given. For example, the physicain orders 14 tablets to be given but the staff gives out 7 or 21.
  • Staff gives out sample to patients without the physician's knowledge.
  • Staff takes medication sample for personal use or to give it to others who is not patient of the particular office.

How do we prevent medical errors or potential errors mentioned above?

  • Disciplinary action must be imposed on any staff who who commits any of the errors above. The severity of the disciplinary action will depend on the severity of the infraction or whether any harm has been done to the patient.
  • The patient should be instructed to always read the information on the drug sample package and the written instruction of how to take that particular medication. If the patient notices any discrepancies, he or she will notify the office before taking that medication.

A policy must be instituted in any office to prevent the aforementioned medication errors or
potential errors.

In my office we have such a policy :

  • Physician writes the sample medication order in the office chart,including the name of the medication;its strength and the dosage direction.
  • The first office staff will take the order by doing the following steps:
  1. Pull the sample medication from the storage .
  2. Makes sure that the pulled medication is exactly the one that the doctor order.
  3. Reminds the doctor if it seems that the doctor has ordered the wrong dose or wrong strength.
  4. Writes the expiration date of the medication in the chart next to the doctor's order.
  5. Writes her initial next to the order.
  6. Writes the name, strength, dosage, and expiration date of the medication on a small paper called patient-instruction sheet.
  7. Let a second staff verify and initial in the chart if if every thing is correct and put her initial next to that of the first staff.
  8. Let the doctor double check everything before signing the patient-instruction sheet.
  9. The first or second staff will then check the sample and direction one more time before giving the medication to the patient.
  10. The medication and the patient instruction sheet is then put into a special bag
    which will have the same function as any prescription bottle. This staff will sign another initial on the chart right before giving the sample medication to the patient.
  11. Instructs the patient to keep the sample medication and the instruction sheet together in the bag. One bag will contain one medication.

Penalty for staff who commits an error by not following the above drug-sample policy:

  • Put on probationary status for 3 months. Possible dismissal if another similar error is committed during this probationary period.
  • Outright dismissal if any staff takes drug sample for personal use without the doctor's permission.

This policy has been in effect for more than 20 years. Staffs comes and go due to different reasons but no one has been dismissed due to committing error by not following the policy carefully. There were a few incidents of probation. On paper, it looks cumbersome but it becomes second nature for my staff in a very short time, with good supervision for new satff.

In conclusion, this policy works.