Northeast Florida Medicine
Vol. 66, No. 1 2015
25
CME
(RLQ) and migration of initial periumbilical pain. In rul-
ing out appendicitis, a few features of the history proved
to be useful absence of RLQ pain. Microscopic hematuria
and pyuria are present in 20 to 30 percent of patients with
appendicitis, but they also occur in many other conditions
and asymptomatic individuals.
Contrast-enhanced CT of the abdomen has become the
most favored of tests to diagnose most intra-abdominal surgi-
cal conditions. It is highly sensitive and specific for detecting
appendicitis, diverticulitis, perforation, abdominal aortic
aneurysm, abscess formation and mesenteric ischemia.
16
Medication Errors
The Institute of Medicine (IOM) issued a press release on
July 20, 2006, stating that medication errors account for the
largest number of errors within the health delivery system,
and annually injure 1.5 million people and treatment of con-
sequences of medication errors costs $3 billion.
26
Medication
packaging, labeling, prescribing and administration systems are
fraught with opportunities for error and breakdown. It has the
biggest exposure for error due to multiple ways medications
are procured, and the constant changing of the look and feel
of various medications as they are created and reincarnated in
iterations of genericmedications.Themainstreampopularityof
over-the-countermedications and supplementsmake the situa-
tion evenmore complex.The report estimates that hospitalized
patients incur an average of one medication error per day. It is
of interest that with the advent of increasingly universal EMR
use, the incidence of medication errors has not been reported
as dropping or improving. Luckily, most cause no real harm.
Again with the topic of communication, inadequate/untimely
communication between physician offices can exacerbate the
problem when patient medication regimes are altered or aug-
mented and interactions are not recognized.
25, 26, 27
To avoid preventable medication errors, the following
should be considered:
• Improve prescription/over-the-counter medication
communication with printed hand-outs
• Improve communication between physicians having
the PCP as the central repository for medication pre-
scribing information for the patient
• Utilize of the National Library of Medicine as an
information repository
• Use IT devices to store prescription and over-the-
counter medication data
• Use E-scribing universally in place
• Use of E-Force, a data base from pharmacies through-
out Florida, to identify which medications patients are
actually filling
• Review medications with the patient at each visit
updating the medical record accordingly.
26
Overall Strategies
to Avoid Medical Error
Unfortunately, medical errors will probably always occur in
some measure. However, there are some key strategies that,
if instituted, can help avoid such errors.
20, 26, 27, 28, 29, 30, 31, 32
In no particular order:
• Comprehensive review of problem and medication
lists with the patient at each visit.
• Effective follow-up systems for managing diagnostic
study results and routinely advising the patient of the
results, on a timely basis. Patients should be advised
when to expect results.
• Documentation of phone conversations with patients
during and after office hours, including what the
patient reported and what the physician advised.
• Regular, thorough patient assessments (include
social and family history) documented for inpatients
and outpatients.
• Monitoring of patients for changes in condition
with actions taken to address the changes, as needed,
and the converse noting when patients have
repeated recurrences.
• Documentation of each patient encounter as contem-
poraneously as possible.
• Documentation that every test ordered or recom-
mended was discussed/explained.
• Documentation of discussions regarding non-compli-
ance with orders and recommendations and the risks
of non-compliance.
• Taking an active role in the event a patient’s insurer
denies a strongly recommended service, medication,
diagnostic study, etc. either by appealing the denial
or having them appeal it depending on their health
plan requirements.
• Documentation for high-risk cases, that the referral
physician is advised of the concerns and reasons
for referral.
• Review of the patient’s chart before the exam includ-
ing diagnostic studies and reports from other physi-
cians and discussing with the patient during the visit.
• Documentation that the preventive health screens rec-
ommended by the physician’s professional association
and societies are offered to the patient and that the
patient is encouraged to undergo them.
