Ways to Improve Medication Safety in the Physicians Office

March 27, 2025

In office settings, situations in which medication errors might occur include injections in the office, samples dispensed by physicians, and prescriptions filled by pharmacies. Following are a few general recommendations to help avoid these errors. Establish written protocols for ordering and/or administration of medications in the office. Medication Safety Protocols:The physician office should address and comply with the following:

Readable medication written orders. If staff is unable to read a handwritten order, the order should be double checked with the physician or practitioner (NP/PA) who wrote it.
If the medication is being e-prescribed the ordering physician or NP/PA should be doing the e-prescribing.
The person(s) responsible for administering oral or injectable medications.
Specific medication(s) that may be administered by individuals based on their level of education and training.
A system of double-checking orders with another clinical staff member to assure the 5 R’s before administration in the office (right drug, right dosage, right site, right time, right person).
A requirement that immediate documentation be made in the patient’s medical record after administration. (This should include at a minimum 1) the name of the drug, 2) the site administered, 3) the lot number and 4) the expiration date).
Procedures to handle questions posed by a patient, parent, or other caregiver. Office personnel should listen and answer questions, as appropriate and, if necessary, double check with the physician or NP/PA.

Do Medication Expiration Dates Matter?
During site visits questions arise about medication expiration dates, their validity, and what should practices do. Does the expiration date on a bottle of medication or injectable mean anything? Can it hurt the patient if they take the oral medication given or receive the injectable that expired or will it simply have lost its potency and do no good?

In 1979 drug manufacturers were required to stamp an expiration date on their products. The medication expiration date means that the medication is safe, the chemical composition is correct and the medication will work as intended if handled and stored appropriately. (The drug manufacture expiration date is just that, the date at which the drug manufacturer can no longer guarantee the full potency and safety of the drug.)

The FDA does NOT recommend that a medication be used after its expiration date.

The FDA States the Following:
The expiration dates on drug products are assigned based on stability testing that is required showing that a medication meets applicable standards of identity, strength, quality, and purity at the time of use. Medications are to be stored and handled according to the labeled storage conditions.

This information is available in the Code of Federal Regulations 21 CFR 211.137,
"(a) To assure that a drug product meets applicable standards of identity, strength, quality, and purity at the time of use, it shall bear an expiration date determined by appropriate stability testing described in 211.166.

(b) Expiration dates shall be related to any storage conditions stated on the labeling, as determined by stability studies described in 211.166.
(c) If the drug product is to be reconstituted at the time of dispensing, its labeling shall bear expiration information for both the reconstituted and unreconstituted drug products.

(d) Expiration dates shall appear on labeling in accordance with the requirements of 201.17 of this chapter."

What Should a Doctor's Office Do?
Offices need to have a process in place which requires that all office medication expiration dates are routinely checked.
The process should include the following:

Identify all medications normally used in the office (i.e. in a procedure room, exam room, office medication refrigerator, emergency carts and sample closets.)
Designate a specific staff member to be responsible for checking expiration dates.
Check all medications at least every thirty (30) days and discard expired medications.

For medicines without an expiration date, unless you know you purchased it/or received it from a drug manufacturer within the past year, it's best to toss it. As time passes, medicines may lose their effectiveness, especially if they are stored in non-optimal environments (I.e. In rare cases, outdated medicines could become toxic. For example, taking expired tetracycline (an antibiotic) can cause serious kidney problems.

When in doubt about administering a medication or injectable that is in question please contact your nearest Pharmacist as they are your best guide to medication administration.