Procedures and protocols in a health care facility are very important regarding the handling, storing and monitoring of drugs. You need a very strict charting system in place and a very specific set of guidelines and rules to follow. You need a chain of command with exceptional ethics, and more than one person keeping track of every single medication carried and distributed within you facility. Our new facility is becoming very popular and busy; we are an urgent care, we have two providers, and x-ray tech, a medical assistant and two front desk employees on staff every day.
We have very strict protocols when it comes to handling, storing, and monitoring drugs that have to be followed on a daily basis. As the department manager I am in charge of keeping track and enforcing all protocols and procedures. The only employees that are able to access medication are the providers and the back office staff which includes x-ray technicians and medical assistants. We have two medication closets where all of our drugs are stored.
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We have one for storing generic drugs such as ibuprofen, Tylenol, phentermine etc. nd another for storing all controlled drugs such as Percocet, vicodin, Tylenol 3, etc. No one is to access the closet containing the controlled drugs alone until all drugs are accounted for and charted first thing in the morning. The providers are the only staff with keys to both the closets. We have a very strict charting system for all medications, generic or controlled, which is to be done in the morning before the day even starts. The provider is responsible for opening the closet and counting all medications with a back office staff member present.
This is charted on a paper document with all mediations listed and both staff members are to sign off. The same process is followed in the evening. This information is then scanned into the computer for electronic record keeping. Throughout the day every medication filled at our facility is dispensed through the computer system, written down on the same sheet and signed off by the provider. One of our big protocols is a staff member with access to the medication closet is not allowed to fill a prescription for themselves even if being seen by the physician on staff that day.
Someone else must dispense their medication. We are currently in the process of having a camera system installed in all closets to insure the staff is monitored at all times while accessing medication. I am responsible for counting all medication stored in our facility once a week with a provider present to insure all medication is accounted for and correct. Today, Rob and Jen are our front desk employees, Dr. Clark is our provider, Jean is our medical assistant and Deanna is our X-ray tech. When they arrive, Dr. Clark and Deanna count and chart all medications, and then the busy day begins.
Thirty patients were seen before eleven o’clock am, in this busy day. At around ten o’clock am, Jean our medical assistant is called home to an emergency while leaving only Deanna and Dr. Clark as our back office staff. Luckily, this was our first instance of slow time. Deanna was complaining of back pain and decides to check in while it’s still slow. She was seen by Dr. Clark. She informs Dr. Clark that she takes an anti-inflammatory drug for swelling and pain on a regular basis but forgot to take it this morning. She asks him if he can prescribe her an anti-inflammatory drug. Dr. Clark prescribes her Diclofenac.
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Although this is a generic Drug, Deanna knows as an employee she is not able to access the prescription closet for her own use, so she asks the provider to fill her prescription. He tells her to do it herself because he is very busy. Now, Deanna explains to Dr. Clark that as an Employee she is not allowed to do this, and he tells her, “It will be fine. ” Deanna knows this is not following protocol and decides to call the department manager. Being the department manager, Deanna explains to me that Dr. Clark had prescribed her an anti-inflammatory medication for swelling and pain.
She explains that he and she are the only back office staff there today and that he stated he is too busy to get her the prescription. She explains that he also stated to get it herself and everything will be fine. I explain that it is company policy not to dispense your own medication and I will come right down to speak with Dr. Clark and help her get her medication. Now as the department manager I could have given her permission to fill her prescription but to keep all protocols and procedures in place I took a drive to the facility and dispensed Deanna’s medication and waited until Dr. Clark had time to sit and speak with me.
Dr. Clark was very surprised to see me in on a Wednesday seeing that I’m only in on Mondays every week to count medication. I let Dr. Clark know that we needed to have a talk. As a manager I have a duty to my company to keep all employees following protocols and I explained that to him. I asked him why he would tell a staff member to fill her own prescription. He began to explain that it was a lapse in his judgment and morals due to a very busy day. He reiterated that it would not happen again. I explained to him our company cannot tolerate working outside of protocols or procedures and I gave him a documented, verbal warning.
Dr. Clark understands but was not happy. At the end of the day, our procedures and protocols regarding the handling, storing, and monitoring of drugs are very clear. They are put in place to protect employees as well as the patient. In this case, the employee was one of the patients. These guidelines are also put in place to follow state and federal law. We have many steps to insure discrepancies cannot happen and when they just so happen to occur we have polices and protocols that I, as a department manager will carry out.
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