Urgent message: Medications can heal, but they can also be deadly. That’s why protocols and controls, supported by rigorous and frequent documentation, are needed to reduce the possibility of medication errors in the urgent care setting.
The most recent 10-year study on medical errors by the Institute of Medicine of the National Academies (sponsored by The Centers for Medicare and Medicaid Services) found that medication errors are by far the most common medical errors, harming at least 1.5 million people every year. These medication errors lead to what’s known clinically as adverse drug events (ADE), defined as harm experienced by patients as a result of exposure to a medication. So, the charge for the urgent care leader is, have your staff take a hard look at the medication practices in your center, then answer the question: Is your center part of the problem, or the solution?
Arriving at the answer will take a thorough examination of the medication practices in your center for safety, compliance, and proper use of logs and controls. In short, a safe medication strategy encompasses a number of different areas for evaluation, and will include several of the areas discussed in this article.
Assure the Right Medication is Prescribed
Some medications that have similar names but very different purposes, such as hydralazine and hydroxyzine, may be easily confused by a provider when selected from a list. To assure that the medication prescribed is the correct one for the patient’s diagnosis:
- Print the patient’s visit summary discharge instructions from the EMR and review these documents with the patient, including patient instructions for taking the meds.
- Review all prescribed meds, including quantities, and check for drug interactions. EMR systems will often alert providers as to potential interactions.
- For narcotic drugs, online state registries can provide information on recent fills, which can also identify medication conflicts as well as drug-seeking behavior.
- Follow up with patients within 24-48 hours of their visit to assure they are recovering and to assess their satisfaction with service received. (The overall importance of follow-up calls was addressed in an article available in the JUCM archives.)
These steps not only protect the patient against medication errors, but increased communication with patients about their meds can improve patient compliance with the provider’s instructions, which should drive better medical outcomes.
Prescription Pad Controls
Although electronic prescriptions are becoming the norm, some providers still rely on paper prescription pads. And even though it’s harder to pull off nowadays, theft, fraud, and abuse of illicitly procured prescription drugs acquired with a forged stolen pad remain a possibility.
Thus, prescription pads still need to be tightly controlled. They should be secured and inaccessible to everyone, including staff, during business hours, and locked up during nonbusiness hours.
National safety regulations indicate than any medication in an urgent care center is to be checked monthly for expiration. For storage, all expiration dates must be circled red on the outer packaging. Additionally, centers should adhere to the following best practices for improved medication safety:
- For centers that do administer narcotics, they must be locked at all times
- Syringes should be stored in locked drawers
- Oral and topical medicines should be separated, either on different labeled shelves or cabinets, to reduce the risk of accidental ingestion.
- OTC medication should only be dispensed in single dose form, with the expiration dates checked monthly.
- Dispose of expired medication only in approved containers.
- Have staff do a thorough inventory of all medication once a month to check for expiration.
Medical refrigerators are designed to rapidly recover their set temperature upon door openings, making them ideal for substances that require strict temperature control. Guidelines for medical refrigerator proper usage include:
- Vaccines should only be stored in medical-grade refrigerators.
- Frequently check temperature alarms to ensure their proper function.
- Make sure that food, specimens, and medications are always stored in separate refrigerators. Label each separate refrigerator appropriately.
- Record temperatures to a log 2-3 time daily.
- To maintain an even temperature throughout the refrigerator, consider placing water bottles on the bottom shelf and side doors.
- To protect the integrity of refrigerated vaccines, consider investing in an automated refrigerator temperature monitoring system to guard against power outages overnight, or if closed for a holiday.
Although medication samples are typically administered to indigent patients, in the absence of strict controls they can end up in the hands of unethical staff members looking to use them for their own purposes. To safeguard sample meds, be sure that the storage area is under lock and key, with only the provider who administers them having access. Additionally, maintain strict logs that document when samples either go in or out, as well as full patient details, dosage, and expiration date.
Although infrequent, an unexpected reaction to even a routine vaccine can trigger a serious condition such as anaphylaxis. As such, your center should be equipped and prepare to deal with the emergency:
- Any location in the center where vaccines are administered should be stocked with an age-appropriate anaphylaxis kit along with a medication checklist and other emergency equipment.
- There should be a twice-yearly review of emergency protocols by the physician, with each protocol having a separate checklist.
- The anaphylaxis kit should be checked monthly for any expired medication, and logged to track the history of checks and who performed them.
Although it seems like medication errors and adverse drug events are on the rise, they don’t have to plague your urgent care and expose you to liability. By simply having rigorous protocols and controls in place supported by thorough and frequent documentation, you can minimize the odds of a medication mishap occurring at your center, and keep your patients and staff safe from harm.
Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine.