By Rolando Morales, RPh
© 2009 The Medical-Legal News
What are the legal ramifications in borrowing patient medications for another patient’s use?
This practice is not an acceptable standard of care in any setting, and bypasses the checks and balances provided by the pharmacy.
Use for another patient constitutes fraud, as the medications have been charged to the patient for which it was prescribed and must be credited back to that same patient.
Governing bodies such as the Joint Commission set standards prohibiting such practice, and facilities tolerating such behavior risk losing their license, and fines.
Never engage in such practice. Follow your facility’s policies on medication administration.
A recent medication error headline involved a verbal order for ephedrine that was mistakenly heard as epinephrine. It involved a 57-year-old woman who became hypotensive and nauseated following excision of a neuroma on her foot.
Not only do the medications sound alike, both are vasoconstrictors and vasopressors that are stored in alphabetical proximity in similarly sized vials.
To help differentiate between these two medications, “tall-man” letters should be used to label the storage containers. (ePHEDrine and EPINEPHrine).
Verbal orders should not be taken unless it is an emergency, and an order should be concurrently written in the patient’s chart and always read back and verified with the prescriber, spelling the medication name.
PCA pump math
Although it is crucial to program PCA pumps accurately, setting a PCA pump at a higher concentration than the actual drug does not necessarily result in an overdose, and setting it at a lower concentration than the actual drug does not result in an underdose.
The concentration of PCA medication and volume are inversely proportional, so a more concentrated drug requires a smaller volume to be delivered than a lesser concentrated drug. For example, to get 1mg of morphine from a standard premixed 1mg/ml syringe requires 1ml of solution.
If it were prepared in a lower concentration, such as 0.1mg/ml, it would require 10ml of solution to deliver 1mg.
When programming the actual dose, care should be taken to correctly enter the drug concentration so the pump can accurately calculate the exact volume needed to safely and effectively relieve the patient’s pain. •
Rolando Morales, RPh, is a pharmacist consultant with DisceRNment, LLC. He and his wife, a legal nurse consultant, are based in Ellijay, Ga.; (706) 636 5276, www.DisceRNment.Biz.