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Thoughts about our responsibility for dosages - AnnieOakley

Posted: Dec 30, 2011

This item was, at some point in time, added to our company standards/specification guidelines regarding dosages. I would like to know if other companies have this same policy, and other MTs thoughts on it. This decision must have been made by an attorney, I don't know, but I question its validity, especially on a verbatim account.

MEDICATIONS: Always verify the correct spelling of medications, including the brand versus generic designation, dosage and frequency of delivery.

Does this mean that we are to check every medication dosage, say Penicillin 250 mg b.i.d. , to see if 250 is a common dosage and that 500 mg is within the allowed daily dosage?? I check mcg or mg as I know most of them and do not have to look them up; the spelling I usually know or it is in the spell check. But I typically do not check the number or frequency unless it is questionable or unless it is a blood thinner. This could take a long time to do in some cases where there are a lot of medications. This transfers the dictators/doctor's responsibility to us. When was this added? I do not see where this should be our ultimate responsibility. The responsibility should lie with the dictator and the doctor who signs off. My beef is that it could be extremely time-consuming. Say 10 minutes for 20 medications. So for 4 reports with 20 medications it could take 40 minutes to verify these.

No, not in real time. It does mean they can nail us for not - on it if they want to, though. NM

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Right there in the contract.

I've Always Checked - Old MT

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I've always checked the mg amount of a drug if I'm not familiar with the drug. Spellcheck where I work used to be okay, but it's totally incorrect now, so now I'm stuck looking up every drug I type if I'm unsure of the spelling.

As far as how many times per day for the drug, I only check that if it sounds off the wall. Xanax 0.25 mg 30 times a day or something--or if there's a discrepancy within the report. We're not physicians or pharmacists and should not expect to be checking 2 times a day vs 4 times a day and things like that. I just use my judgment on those.

Re verbatim--I've never had one so strict that even known incorrect information gets typed, but if I did, I'd leave it blank anyway and let them worry about it.

Checking - Old MT

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I hear what you're saying, and I'm not slamming you. I'm getting paid the same crud for the ASR nonsense, so I do sympathize.

I can definitely transcribe 98% of this ASR nonsense faster than I can edit it. I think this week I actually had one doctor who didn't back up over his words--that *I* had to fix.

I guess we have to find a mid point now. We still have to remember there's a patient behind that report.

I'm looking for another career. Until then, I'm just doing the best I can and biding my time. I've given up hope that we'll ever actually be paid what we're worth anymore.

I left Focus finally because of something - like that

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I had a lot of issues with Focus to start with and multiple signs from the universe that starting with them was a bad idea, but I didn't listen. The final kicker was when I got a major error (it was indeed an error) for a medication dosage that was wrong. I wasn't familiar enough with the med to know and it was what the doctor (a resident, of course) dictated. When the correction came back, I asked my TL about it, saying since we couldn't listen to the audio I was wondering if she really did say 120 mg or she stuttered and said 20 mg and I just heard 120 and since that was what was on the screen my brain didn't correct it. My TL came back and said, it is the MTs responsibility to verify dosages. I said "huh?" what do you mean verify dosages and how, exactly, do you mean that. She came back and said I could use Drugs.com.

Huh. Really. For 4 stinking cents a line I'm supposed to double check the doctors. Nope. Don't think so. I do my absolute best to produce a quality document, sometimes to my own detriment because I spend too much time looking up a blank, and if a med seems really wrong to me then yes, absolutely I will look it up and verify it. But to verify every single dosage? Nope. Not doing it. If it is dictated wrong it's on the doctor not us.

Well... - Sorry Charlie

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So what you are saying is, if you've never heard of a med and you have no clue if it comes in that mg, you just type it?

Not really, no - Former focus

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I can see what you're saying and if it was a med that I had never heard before, then the possibility exists that I would check it. I can also truthfully say that even if it was one I never heard before, if the dictator clearly stated 120 mg, then no, I might not check. Flame me for that if you will, but my job is not to double check everything the doctor says. My job is to transcribe what they are saying to the best of my ability. That's why they have 12 years of schooling behind them and get paid a boat load more than I do and that's why their name is the one that is signing the document.

The line rate also plays into this and I know people have been flamed for this type of attitude in the past. I have a straight typing job for close to 9 cpl and I hate to admit it, but I do take more time to double check things because I know I CAN take the time and it won't hurt me financially. At 4 cpl, I only have the time to edit what the doctor says. If it's clearly wrong, I fix it or flag it, but quite frankly if it's going to take more than a couple of minutes to figure out, it gets a blank. On the medication scenario I referred to in my first post, it was pretty clear (I thought at the time anyway) so there was no reason in my mind to flag it. At 4 cpl I'm just flat out not going to double check every medication on a patient's list to verify that the doctor is giving the correct information. That's the doctor's job and I can't afford for it to be mine.

This reality is what I mean about "not in real time." Of - course we check what we know we

[ In Reply To ..]
do not know, but we're just not paid enough to assume responsibility for confirming all dosages. When we were usually paid hourly, yes, but not now. Nobody expects it, or wants us to slow down production to do that, not our employers and not the dictators, but we make good fall guys when something goes wrong.

Whether it hurts you financially or not - Old Pro

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should not be your first consideration. WHAT ABOUT THE PATIENT?

Yes, you should check it - Old Pro

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Someone's life could depend on it. I don't care if you are being paid 4 cents or 4 dollars a line, there is a professional responsibility there. You likely could not be sued, but you could save a life.

Checking medications - Old Pro

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I always, always, always checked if unsure of anything with meds. However, legally, the physician is what is known in the law as "the captain of the ship." That means that he or she bears the legal responsibility for what those under him or her do.

The burden of accuracy seems to be getting more and more up to the MT. - IAMT

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If the provider enters the wrong patient, it is told to us by the MTSO that it is our responsibility to do the search and enter the correct patient. If the dictator gives the wrong gender (sometimes not obvious), it is our responsibility to correct it. If the dictator sends a CC: and it is not in their listing, it is our responsibility to do a search, find it, add it and pend it with the same information at my previous company. We were not paid for headers, pend notes, CC's, or our research time. Obviously, when switched to a new account or having a new set of specifics added, we lose for a while in the way of learning curve anyway, so add this to the above and looking up dosages, my paychecks dropped so significantly I decided to leave. I think the MTSO still thinks they were giving me an "opportunity" to learn 9 new accounts in a month. Also decided if I am going to get chastised for being accurate and not meeting line count regardless of my accurate reports along with the drop in pay, why should I stay?

Medications, yes you should check! - luckyladyinca

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Yes, but you will learn over the years. I have caught numerous fatal errors during my career. Of particular note, one dictator made so many mistakes that I refused to transcribe her dictation, and she was fired shortly after, ironically for the same errors I had flagged.

Use an expander to do your work for you - sm

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I have a shorthand drug dictionary with entries for the top 200 drugs plus whatever comes up during my workday (I add them with a prefix as they come up then expand their entries after my shift).

Each drug has 2 main types of entries, brand and generic, plus nonprinting tags for generic (for brand entries) or brand (for generic entries) names and dosage info. I have entries for just the drug names and drug names plus doses and some even with dosages (most notably Plavix).

It saves a bunch of research time, and since the Spellchecker at my company is a sabateur, it's saved my butt more times than I can count. That little dictionary would get a spa day from me if it was a human. Half the drug entries are misspelled so aren't caught by the blasted thing. Guaifenesin alone has 6 correct spellings.

side rant: How hard is it for medical spellcheck companies to fix gentamycin?

Ask yourself if it was your record would you want - it to be accurate? nm

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supposed to be in response to OP - nm

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