Medication administration is commonly the responsibility of medical assistants (MAs) in many California medical offices and clinic settings. While MAs play a vital role in carrying out a variety of routine tasks that keep your office running smoothly, they may also represent an underappreciated source of risk for your practice. Unfortunately, many physicians fail to understand that MAs are unlicensed individuals with limited, if any, formal education in pharmacology and safe medication administration.
In fact, a recent focused review by CAP Risk Management and Patient Safety staff reveals that medication errors, where an MA was directly responsible for a patient’s injury, accounted for the most frequent cause of loss in indemnity.
Medication Errors - 49%
Failure to Monitor - 25%
Office System Errors – 12%
Interestingly, the majority of these medication errors occurred in busy primary care offices, such as Pediatrics, Family Practice, General Practice, and Internal Medicine, often as a result of the MA violating the tenets of safe medication administration — the right patient, the right drug, the right dosage, the right time, via the right route. It was discovered that 62 percent of these errors involved injectable medication, such as vaccines, antibiotics, numbing agents, and corticosteroids. A perfect example is a case where Patient A received the allergy medication intended for Patient B. Sadly, Patient A experienced anaphylaxis, an emergency trip to the hospital, and subsequent emotional distress. CAP paid $15,000 in indemnity and $16,917 in expenses.
Surprisingly, one particular medication made a frequent appearance in our closed claims review — the glucocorticoid corticosteroid, Kenalog. The most recent and notable case involved a 31-year-old female who was being treated for an insect bite and received a Kenalog injection in her right upper arm by an MA. The patient later complained of right arm weakness, as well as a palpable lump, a tingling sensation, and pain at the injection site. It was determined that the drug leaked out into the patient’s surrounding adipose tissue, causing necrosis and dimpling. With proper trainingand supervision, the MA would have known to inject the drug employing a Z-track technique deep into the gluteal muscle using a needle at least 1.5 inches long, as indicated in the manufacturer’s medication insert. The case settled for $29,999 with $20,679.57 in expenses.
The third-highest cause of claims where indemnity was paid resulted from a failure to monitor a patient within the office environment and exam room. Interestingly, more than half of the injuries sustained occurred from a fall shortly after the administration of a vaccine. Unfortunately, these patients were not monitored closely after receiving their immunizations. Many of them experienced side effects, including a loss in consciousness, causing them to fall and sustain injuries to their heads and faces.
So, how can you keep your patients safe and minimize the possibility that your MA will make a medication error? First of all, be familiar with your MA's full scope of practice, as described by the Medical Board of California. Hire individuals who can provide a certificate of training from a respected institution and demonstrate competency in pharmacology and safe medication administration. If your MA will be giving injections, such as Kenalog and vaccines, and administering inhalation medications, it is essential that you provide them with additional training required to do this safely.
Next, employ office systems and practices that emphasize medication safety. Develop and implement clear policies and procedures, including refill guidelines. Keep in mind, MAs may not call in new prescriptions or any refill prescriptions that have changes. Other recommended practices include:
- utilizing chart alerts for patient drug allergies
- storing “look-alike, sound-alike” drugs separately
- labeling syringes
- giving medication to only one patient at a time
- limiting distractions when giving meds
Last but not least, understand your responsibilities as supervisor. An MA can only provide patient care under your direct supervision or under the supervision of a physician assistant, nurse practitioner, or nurse midwife. You or the supervisor must be on the premises at all times when the MA is providing patient care. So, before an MA administers any authorized medication, a supervisor should verify that the right dosage, of the right medication, is given to the right patient, at the right time, via the right route, each and every time.
Medication errors are preventable. When well-trained medical assistants act within their scope of practice and adhere to comprehensive medication administration procedures and protocols under your direct supervision, the less likely a medication error will occur. Safe medication administration improves patient care and reduces your medical liability risk.
CAP’s Risk Management Institute
CAP's Risk Management Institute has provided online risk management training to more than 1,000 medical office staff. Designed specifically for front and back office staff, the Risk Management Institute is available exclusively to CAP member practices free of charge.
The six training sessions included in the Risk Management Institute address the questions most frequently asked by callers to our member hotline. The 20 to 25 minute sessions address the following topics:
- Informed Consent
- Medication Management
- Effective Office Communication
- Patient Education
- Tracking and Recall
- Medical Record Management
The program helps to ensure that your office staff members are focused on key risk management issues, as they more effectively serve your patients. CAP members find the program is helpful in reducing risk in the office.
To take advantage of this free member benefit, please contact our Risk Management and Patient Safety Department at 800-252-7706, extension 8502, or riskmanagement@CAPphysicians.com to obtain the necessary password and registration instructions.
“Call to Action” Items
- CAP’s Risk Management Institute (for information, contact Alicia Alexander at 800-252-7706, ext. 8644).
- CAP Risk E-Notes (visit our website at www.capphysicians.com/risk-management/publications#risk-enotes to review the library of issues).
- Medical Board of California (www.mbc.ca.gov).
Amy McLain is a Senior Risk Management and Patient Safety Specialist for CAP. Questions or comments related to this article should be directed to amclain@CAPphysicians.com. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.