A medical assistant's lack of understanding of basic math could have killed me

[Paula Sims]

I went to my allergist's office today to get my monthly shot. Because I have a bizarre mix (I have a horrible immune system) I watch closely what I'm given and in what dosages.

One of my shots is set for .15cc and I noticed that the person giving the injection (not a nurse, PA, or doctor) was using a different syringe (bigger) and she wrote down 1.5cc on my chart (thank goodness for electronic charting -- the only time I'm happy about it). I told her that was too much and that she was using a syringe with a different unit measurement. She told me that the needle only looks different and that 1.5cc is the same as .15cc. I REFUSED the shot and demanded that I see the doctor. The assistant wanted to throw away the needle but I made her give it to me (she was going to charge me for it -- fine) and held it to show the doctor.

When I finally saw the doctor (she made me wait 45 minutes, "forgetting to tell the doctor" and I caught him on the way out), I showed him what she was going to give me and he was horrified. Yes, he adjusted things to the right dose and then told me he'll "take care of the situation" in the morning. I truly believe him because that would have been a malpractice suit. My only concern is how many other people did she screw up and they didn't know it? Since I have known this doctor for over 20 years and know his euphemisms, I know she'll be fired in the morning.

This woman is not a kid -- she is in her mid 20's at least, and to not know the difference between .15 and 1.5 and then use a larger syringe that has different units?!?! She also bragged that she couldn't pronounce my name (PAULA?!?!?) and that she called me in by saying "you're next" (there were several people in the room). Yes, she'll be gone in the morning (the nursing staff also witnessed this).

I'm shocked about the level of education that passes these days. I'm not asking for differential calculus - I do that on my own every day. But goodness golly gracious stars & bars (to misquote Rumsfeld) -- THAT dumb? Please God let this be an anomaly. Sadly, I don't think it is. . .

[Laffy Kat]

1. Wow. I'm surprised they even let an MA give allergy shots.

Glad you're OK.

[Warpy]

2. They're trying to expand the roles of unlicensed personnel

because licensed nurses are expensive. This is industry wide.

I'm a retired RN and you bet I keep my eyes wide open, too.

[Kalidurga]

5. My middle child is a medical assistant

They have her do a lot of things that a nurse is supposed to do. I don't even know what duties are supposed to be done by who anymore the lines have blurred that much. I have had medical assistants take my temp, my blood pressure, and give me shots.

[Laffy Kat]

6. I'm an EMT and I sure wouldn't feel comfortable giving allergy shots.

Starting IVs, fine; taking blood, fine; but allergy shots are another animal. It should at least be drawn up by an RN, not even an LPN.

[Kalidurga]

7. In don't get allergy shot, just flu shots

I don't know how many different kinds of shots my daughter gives, she has mentioned that is part of her job though.

[Horse with no Name]

13. You are aware that many LPN's have as much or more experience doing these types of things

as RN's?

In Texas, there are only 3 things that by license they can't do and giving allergy shots isn't one of them.

I wouldn't want an EMT giving shots....but simply because they aren't trained to do so, not because they are trained but I won't allow them to do what their training allows them to do. It would be the same thing for me to call 911 and ask them to only send licensed paramedics because they are better than EMT's. You and I both know that is silly--many EMT's have the experience necessary to do most of the stuff in the field that any well trained paramedic can.

I have been a nurse for many years and there are many LPN's that I would allow to care for me before I would certain RN's.

Allergy shots are a dangerous animal. Any licensed personnel is allowed to give them. That being said. A Medical Assistant CAN give allergy shots--and when they say supervised what that really means is that she is working under someone else's state license. Sometimes it is a supervising nurse and sometimes it is the doctor himself. Someone is responsible for her actions. They should be a little more wary of who they allow to destroy their career.

[Laffy Kat]

16. I guess I disagree, respectfully.

Paramedics have much more experience than EMTs and there are MANY things medics can do in which EMTs cannot. In my state an EMT can't even go through paramedic training until they've had at least six months in the field and several more courses. If I thought I was having a heart attack I would specifically ask them to send a paramedic, as they are trained in advanced life support where EMTs are not. In Colorado EMTs cannot use intubation devices (except the King Airway). Yes, it is true I've known some incredibly capable LPNs and a few incompetent RNs for that matter. But I still think an allergy shot should be drawn by someone with more training than an MA or LPN. It probably varies by state, but in Colorado an LPN is not allowed to administer many oral meds. depending on the Schedule rating.

Thanks for being a nurse, BTW. I admire nurses so very much.

[Horse with no Name]

19. :)

Maybe it is a state thing because I have worked with LVN's who have been certified in ACLS, PALS, NRP, and TNCC and RN's who only had their BLS. Guess which one I would choose? LOL

And the EMT's I know? I would trust them over a doctor in many cases.

I worked codes at Children's Medical Center in Dallas which is a pretty prestigious place and on more than one occasion, they had EMT's doing the airways.

Looking at the scope of practice of LPN's in Colorado, I see that their schooling isn't as long as it is in Texas which means that they don't learn the same things and their scope limits them to what they learn in school--whereas Texas does allow for further certification after graduation. It also limits them to patients with predictable outcomes--so obviously the critical care areas aren't included. Interesting. So LPN school there is a lot like MA school here. Without looking, I am going to assume that MA school would be a lot like a CNA here. Definitely can see what perspective you are coming from.

yw

[Warpy]

8. Temp and BP are fine, that's what they're supposed to do

Drawing up and administering shots? Not so much...

[Runningdawg]

32. I am retired as well but 2nd this

My BIL is a recent BSN graduate. The horror stories he has told! He works in the major trauma center in the DFW area and says most of the support staff are hired from agencies that offer 10 day courses. Some workers received their training as part of work release program, others as part of a drug rehab program.
3 years ago my father was in a small-town hospital. I caught his RN trying to pass off aspirin as his pain medication - which was in HER pocket. When I called her on it she claimed the aspirin was IN ADDITION to the pain med....funny thing - he didn't have a fever. Her nursing supervisor and I had discussion. She said she would handle it, but she also didn't seem shocked at the allegation.

[joeglow3]

41. We have a winner. My wife is the last RN in her office.

And the only reason they keep her is her pay is low (a trade off we accept for the flexibility she gets with the job).

[Paula Sims]

3. I was too

and prior to this one, it was OK. I didn't know it was legal in my state. I was also told and it was noted on my chart -- TO BE ADMINISTERED BY NURSE, PA, OR DOCTOR ONLY!! (yes, in all caps).

Thanks

[Ilsa]

9. This MA wasn't being supervised?

This was the kind of error that would get a nursing student sent to remedial lab for several weeks for being unsafe. Unlicensed personnel need better supervision than what was going on in that office. I'm relieved that the error was caught by you and that you're okay.

[Odin2005]

4. I wonder how many people this arrogant moron has injured or killed.

[Ilsa]

10. Under the "supervision" of someone licensed.

A person with this skill set probably doesn't know enough to realize that she doesn't know what the hell she's doing. I'm shocked she was allowed to do something so dangerous.

[Odin2005]

23. The Dunning-Kreuger Effect.

She's so dumb she doesn't know she is dumb.

[hamsterjill]

29. Exactly!

Even when confronted with her error, she didn't question herself. She went forward with an incorrect explanation that just dug the whole even deeper.

I think a dose of humility might be a good thing for this person. But that may be wishful thinking...

[Hoyt]

11. Sounds like a complaint should be filed against physician who is responsible.

[demmiblue]

12. I wonder if he was horrified because...

he was completely at fault for allowing this to happen. Allowing unquallified staff to perform medical care is totally on him. Totally. Sure he will try to pawn it off, but it is 100% on him. Hire qualified medical staff, dumbass.

[TorchTheWitch]

43. ^^^THIS^^^

I'm perplexed by all the blame falling on the employee. She was hired to do a job she doesn't have the education or training for, and the fault for that is on who hired her, not her for not knowing how to do the job and being left to her own devises to puzzle it out for herself without on the job training or supervision. And the doctor who is solely responsible for hiring someone unqualified and not giving them training or supervision lays the blame for the mistake on the employee who he'll likely fire and hire some other equally unqualified person in her place just to save a buck.

This doctor hired someone woefully unqualified and without on the job training or supervision and threw them at his patients knowing full well that grievous and life threatening mistakes would LIKELY be made then blames that unqualified, untrained and unsupervised employee for them. HE's the one responsible to provide his patients with qualified staff and that anyone unlicensed to draw and give any medication to a patient is properly supervised by a licensed professional - HIM.

[MisterP]

14. and 1.5cc looks nothing like 0.15--it's something anyone could perceive

[lpbk2713]

15. That is scary.

I'm glad you're still here to tell us about it.

[AtomicKitten]

17. That is concerning but glad you caught it.

Right after I had my daughter, an R.N. came in with a shot for me. I asked her what it was and she said it was RhoGAM (an immunoglobulin for Rh negative mothers to prevent Rh incompatibility in subsequent pregnancies). I informed her I am Rh positive and her response was "whoops."

Whoops. Holy shit.

[Horse with no Name]

20. I always hated giving the Rhogam shots

I know they hurt.
However, if you did get it, it wouldn't cause harm other than the pain that the shot gave or one of the rare side effects from the actual injection itself despite the rh factor.

That being said...it sucks when nurses don't take the time to make sure that someone needs or doesn't need something. It creates unnecessary medical intervention and truly makes people uneasy that they might be given something detrimental to their health and rightfully so.

[laundry_queen]

22. That same thing happened to me.

After one of my kids' births (cannot remember which one - not the first one - I have 4). I had to REALLY be insistent too that I was RH positive ("are you sure? I was told to give this shot to you because you were negative. Do you know what RH negative is?" Um, hell yes I do this is not my first kid and I'm NOT NEGATIVE). I had to insist I was refusing the shot. She finally said, "let's check your chart. Oh, yeah, you're right, you are positive. It says right here, "O positive". I had better go check who this was meant for then." You think? Geez.

After my first daughter was born, I had a C-section under a general. The nurses then forgot to give me any painkillers for 24 hours. I didn't know that was abnormal because I was young and had nothing to compare it too, and thought crippling pain after a C-section was normal. When I couldn't even get up and walk, after some comments about my pain tolerance level, one of the nurses checked the chart and starting asking around if any of them had given me any shots of Demerol and not written it down. When they all realized I hadn't been given anything for 24 hours after major surgery, they were a lot nicer about my 'pain tolerance'.

Oh, and in the same topic - babies - when my second was born, I went home really early (no C-section, felt like a million bucks, left the hospital less than 12 hours later...I'd have liked to have seen those same nurses talking about my 'pain tolerance' then) and of course, had to come back because baby was jaundiced. I had a major fight on my hands because some dumbass nurse insisted on turning up the incubator thingy up to 38 degrees Celcius (100 F) I told her that was TOO WARM for a full term baby. I showed her the chart printed ON THE STUPID WARMER ITSELF and she told me, "oh, that chart is wrong". She turned it up and left, while I watched my newborn start to SWEAT. So I opened the arm holes to let the heat out, then I kept taking her out, which was so counterproductive because she needed to be under the bili lights, but I didn't want her dehydrated either because it would make the problem worse. We had to stay for 2 days, but most of the time I was taking my baby out of the warmer and lights on the sly so she didn't fry. When I went home I did some research and found the chart on the warmer was right - full term only needs 30-32 degrees to maintain body temperature while naked. I told my doctor (small town, he ran the hospital too) and he freaked and said he'd get that straightened out. Unreal. Don't know what happened to THAT nurse.

Moral of the story is if you can, educate yourself about all procedures before they happen. It's easier now with smartphones, you can look things up while waiting in the office.

[Odin2005]

24. Given the types of people I see wanting to be nurses...

...each and every one of them should be assumed to be morons with a below average IQ until proven otherwise.

[Horse with no Name]

26. the problem is that there is a lot of ageism in nursing

new inexperienced nurses are so much cheaper than nurses who have knowledge and with the types of tort reform in some states, the hospitals really don't care much about anything except the bottom line and if the laws limit lawsuits, then that is a bonus.
In my last few years of nursing, I worked with some of the most inexperienced and dangerous nurses that I have ever seen collectively in my entire career.
So many get into it now because of the paycheck and honestly--there isn't enough money in the world to do some of the things that we are asked to do if you don't care about the patients and love doing what you do. Unfortunately, many of the new nurses who get into it for the wrong reasons find this out. Instead of leaving the profession behind, they cling to the paycheck and the patients suffer greatly from their apathy and uncaring inattention to detail.
I am not saying that EVERY new nurse is this way, because they aren't. There are some very fine practitioners out there who strive to be the best that they can be. The problem is, the ones that don't care are shoving out the ones who do in record numbers because they are cheaper and younger and perceived to be a healthier workforce. During my entire career I have advocated to families to please be present during a loved ones hospitalization. Pay attention, ask questions and be diligent. Those are the situations where mistakes are least likely to be made because it is noted that someone is watching. Many new nurses call these difficult family members. My advice? Live up to that accusation. Your loved one will be better for it.

[Odin2005]

31. "So many get into it now for the paycheck" That is my own experience.

I grew up in a lower income rural area and I saw that lower income women who did not do well in school almost all wanted to go into either Nursing or Cosmetology. They are seen as "trash" careers for working class young women who "were not good enough" for other professions.

[Warpy]

33. Morons don't survive all the hard sciences nurses have to take

Shame on you.

Most nursing schools have high washout rates, the people besotted by nurses on TV and in young adult fiction not being able to cope with not only the hard sciences but the realities of shit, piss, vomit, pain, misery, and death.

[Odin2005]

34. Just because they passed an anatomy class doesn't mean...

...anything stuck with them after the last test.

[Warpy]

36. You obviously don't know any nurses

and it's not just an anatomy class. It's chemistry, organic chemistry, microbiology, and physiology in addition to the nursing core, social sciences, statistics.

While many nurses can't recite things like the arachidonic acid cascade or draw the Krebs cycle once they are five years out of school, they do recognize where in the processes a new drug is targeted when they see one.

Again, shame on you. One of these days, your life will depend on one of us "dummies" who went into a "trash career" because we "weren't smart enough to do anything else."

I survived engineering school. Nursing school was harder.

[Ilsa]

37. Agreed. My first degree required a significant amount

of mathematics and statistics. Nursing exams were infinitely more difficult with multiple good answers (find the best answer) and the amount of material covered was daunting. It was a whole new level of critical thinking. The ones who didn't have the skill or discipline washed out.

[Dorian Gray]

38. great post

don't let the ignorance get to you.

[phylny]

40. The nursing care I received before, during, and after my surgery in March

was nothing short of superb. Maybe spectacular. When I was asked to complete a hospital survey, I praised the nursing staff, who did everything to help me, keep me comfortable, answer my questions when the doctor didn't ("Were any of the lymph nodes positive?" No) and explained everything they did and why.

I couldn't do the job, that's for sure.

[magical thyme]

25. Nurses don't do blood typing; the lab techs do blood typing and would not have delivered

Rhogam to an Rh positive patient. So there was more than one person at fault there.

If the nurse ordered Rhogam, the lab tech should have advised him/her the patient was Rh pos. And when we deliver Rhogam to the nurses, we tell them who it is for, review the paperwork with them and they sign for it.

Possibly she was trying to give you another patient's dose...maybe she failed to check your name against the paperwork.

[Horse with no Name]

27. These are the new checks and balances

In the old days...it was readily available on the unit.

[RobinA]

46. Sounds Like

The time my mother went to have her Celebrex prescription filled and got home to discover she had been given Coumadin. She went back to the pharmacy and the response was that they both begin with " C."

[Samantha]

18. I had a scare last month I want to share with you

Last edited Sat Dec 13, 2014, 12:26 AM - Edit history (1)

I take one of those prescriptions one can't discontinue suddenly. A consumer has to slowly wean oneself off the drug gradually or a heart attack can result from the sudden withdrawal.

Last month, I had the prescription filled (from a paper script). I waited for it. As I was walking out of the drugstore, I wanted to check the number of pills to make sure I had been given enough for the month. I was shocked to realize when I pulled the bottle out of the bag to see the pills in the bottle were not "my" pills. I went back to the pharmacist and reported the error. He too was shocked.

Someone was working there that day who was new. She was either an intern or someone in school putting in a few hours perhaps for ojt.

I believe pharmacies do take shortcuts to cut costs, perhaps doctors' offices do as well, but that is potentially a deadly way to save money.

Sam

[Horse with no Name]

21. What a horrible experience

I am a woman and picked up a prescription at CVS. I was aware of what my doctor had called in and the drug I picked up was for male prostate issues....

I called the pharmacist and told him I was bringing the medicine back. He was so rude to me. I gave him every opportunity to do it the right way. So after he acted like an asshole...I then told him what the medicine was that had been filled (he kept telling me I was wrong) and then I reminded him of another medication that I was taking (the two have severe interaction issues). Then he got all nicey nice and told me to bring it back and he would fix it immediately. I was even given a $50 giftcard for my trouble.
It was the last prescription that I ever had filled there.
People have to be so vigilant because there are so many places that the system can break down and actually cause real and significant harm to the patients and you are correct. Most of it has to do with cost savings.

[Samantha]

44. This is an excellent warning you have given everyone

I really never thought I would see the day when so many mistakes were being made by pharmacists, but here we are.

Sam

[Horse with no Name]

47. Thank you.

Interestingly enough, that wasn't the first medication error CVS had made for me. Luckily, I am a nurse and know exactly what my doctors prescribe and why it is prescribed, etc. I am fortunate enough to have that knowledge that keeps me safe.
One other time, I was given seizure medication instead of my migraine medication.
However, the reaction that I received when I notified them of the error was distinctly different the first time so I was willing to overlook it. But the rudeness and asshattery the second time was over the top. I'm petty like that. lol

[Warpy]

35. If you take generics

bookmark this site: http://www.healthline.com/pill-identifier

Different manufacturers can make the same drugs different shapes and colors with different ID marks. Whenever a pharmacy changes manufacturer, I always ID the pills when I get home. It's just another level of safety.

The ridiculous speedup that has taken place in hospitals and pharmacies has made them dangerous. You have to learn to be your own advocate, and this is one tool for you to use.

[Samantha]

42. This is true and good information for everyone to have

But in this case, when I looked at the name printed on the bottle it was similar to the name of my pills but not close enough to make this mistake. It even started with a different letter. I had told the young woman behind the counter when I gave her the prescription that I had had it filled there for a couple of years and that all the info was in their computer software.

I think she just didn't have enough experience to be allowed to fill prescriptions on her own. If she was in training, the pharmacist should have doublechecked her work. Just my opinion.

Sam

[KingCharlemagne]

28. Your OP and the comments it has occasioned have well and truly scared the

living Be-Jesus out of me! One of the last institutions in our society that I felt comfortable giving my trust and now it too has -- POOF! -- gone with the wind.

I suppose I should say 'thanks' for the valuable pulbic service you are performing here, even though I now feel a bit rueful for my earlier naivete.

[hamsterjill]

30. I'm glad you stuck up for yourself!

It's important that we, as patients, understand what we are receiving and do just as you did - verify and refuse if necessary.

You did absolutely the right thing by advocating for yourself!

[LiberalElite]

39. How did this person graduate much less hired? nt

[Avalux]

45. An MA is NOT qualified to give injections.

They get about six weeks of basic training; it's enough to do BPs, temps, and take a basic medical history. Maybe perform phlebotomies. But to inject medications - wow, NO.

Your doc is responsible for anything she does under his supervision. Either he knew about it and condoned it, or he didn't and the nurse had her doing it. Either way, he needs to run a tighter shop.