Physician offices which administer medications need to consider all the risks involved in this practice. Princeton cases, and those in the industry, show that office staff give incorrect medications or dosages just as their hospital counterparts do. In fact, since offices can present more distractions and interruptions than a typical facility nurse might encounter, it could be postulated that medication administration in the physician office might even be more risky.
Princeton Insurance policyholder, Doctor Neil Minikes’ office administers allergy injections. After hearing a medication safety tip from the asthma and allergy specialty community, Dr. Minikes instituted a double-check system for medication administration in his practice. In his office, the nurse who prepares the injection follows a checklist. First the patient’s immunotherapy flowsheet is pulled and reviewed; then the patient’s allergen vial(s) is/are checked against the flowsheet. Finally, the prescribed dosage is checked against both flowsheet and vial. The nurse then initials his/her work. A second nurse or physician double-checks each step and also initials the sheet before the injection is given.
Double-checking medications is particularly important when the medications can have serious side effects (which can be true of most medications if they are dosed incorrectly), when the patient population is already vulnerable (such as in an oncology or geriatric practice), or when the circumstances of administration are particularly susceptible to error (for instance, when medication administration is routinized such as in allergy practices, or when the nurse or physician is frequently interrupted).
Each practice which gives medications, whether routinely or even on rare occasions should:
û Review and carefully assess their medication administration practice, looking for areas which could create error
û Review any medication administration errors or near-misses which have already occurred in the practice to identify areas of the process which created the error or near-miss
û Develop a system which will meet the needs of physician, staff, and patients while reducing the potential for error
û Such a system should:
o Be as uncomplicated as possible
o Use as few steps as necessary to achieve effectiveness and error reduction/prevention
o Be the result of a team effort on the part of physician and staff, with buy-in by all before implementation
o Should include physical factors (office and room layouts), supply needs, and documentation needs in its development
o Should include a regular review for possible “tweaks” to the system; this review should occur at least annually and should also be done after any error or near-miss
Putting this much thought and effort into medication administration may lead to better patient safety, ease of use for staff, and a reduction in potential claims.