© 2010 Pharmacists Mutual Ins. Co.

Medication Errors: What Are The Risks and What Can I Do About Them?

Medication Errors: What Are The Risks and What Can I Do About Them?

by Don R. McGuire Jr., R. Ph., J.D.General Counsel

Pharmacists Mutual Insurance Company

May 14, 2010

Maine Pharmacy Association

© 2010 Pharmacists Mutual Ins. Co.

Intentional Torts

Assault Battery False Imprisonment Defamation Invasion of Privacy Malicious

Prosecution

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Negligence

Elements –Duty–Breach of Duty

–Damages–Proximate Cause

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Duty

The requirement to behave in a certain manner for the benefit another

Does not mean warning about everything

The actor must take reasonable steps to prevent foreseeable harm

Professionals have different duties than “ordinary” people

© 2010 Pharmacists Mutual Ins. Co.

Breach of Duty

Standard of Care – how you know when the duty is performed

Reasonable Person Standard – what would a reasonable person do in the same or similar circumstances?

Legal Standard – law requires certain behavior

Others – professions, codes of ethics, etc.

© 2010 Pharmacists Mutual Ins. Co.

Breach of Duty

Failure to perform the Duty (nonfeasance)

Duty performed inadequately or incorrectly (malfeasance)

Breach when Rx filled incorrectly easy to spot

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Proximate Cause

The breach of the duty must be the direct cause of the injury

Superceding or Interceding Cause

Can be lack of drug or addition of drug or both

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Damages (Harm)

Patient must have been harmed in order to be compensated

Many states require underlying physical injury to make claim for emotional injury

Harm if not taken?

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Defenses to Negligence

Contributory Negligence

Comparative Fault

Assumption of the Risk

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Contributory Negligence

Common law concept Plaintiff cannot be even 1% at

fault and still recover Defense merely needs to show

some fault by plaintiff to win

© 2010 Pharmacists Mutual Ins. Co.

Comparative Fault

Replaces Contributory Negligence Plaintiff has their percentage of

fault subtracted from the damages award

2 versions – Pure - plaintiff recovers damages, less their % of fault–Modified – If plaintiff responsible

for 50% or more, then no recovery

© 2010 Pharmacists Mutual Ins. Co.

Remedies

Compensatory Damages

Punitive Damages and Exemplary Damages

Injunction

© 2010 Pharmacists Mutual Ins. Co.

What Can I Do?Protect yourself & your patient!

Risk Management Techniques

1. Avoid the risk.2. Control the environment.3. Retention of the financial risk.

4. Transfer of the financial risk.

© 2010 Pharmacists Mutual Ins. Co.

1. Identify the Risk2. Select the Technique3. Implement the Technique

4. Monitor and make necessary changes

Controlling the environment--

The Risk Management Process

© 2010 Pharmacists Mutual Ins. Co.

Pharmacists Mutual Claims Study 2010

1989 through 2009

Notes: *Non-bodily Injury = release of conf. information, false arrest, libel, slander

49.8%

27.5%

9.0%1.7% 7.9% 1.6%

2.5%

© 2010 Pharmacists Mutual Ins. Co.

Pharmacists Mutual Claims Study 2010

1989 through 2009*Others

Compounding

Illegal

Generic

C.R. Cap

0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4%

1.4%

0.3%

0.6%

0.2%

© 2010 Pharmacists Mutual Ins. Co.

Pharmacists Mutual Claims Study 2010

Drugs Delivered in Mechanical Claims 1996-2009

Coumad

in®

Levoth

yroxin

e

Anti Diab

etics

amox

icillin

/Aug

men

tin®

Topro

l®/m

etop

rolo

l

amitr

ipty

line/E

lavil®

lisin

opril

predniso

ne

insu

lin

aten

olol

Lipito

r®

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

7.5%6.1%

4.6%

3.5% 3.5% 3.3% 3.3% 3.2% 3.2% 3.0% 2.9%

© 2010 Pharmacists Mutual Ins. Co.

Triple Check . . .. . . Plus Two

Check three timesPlus 1 --Check NDC numbers

Plus 2 --"Show & Tell"–Never deliver a

prescription "in a bag"

© 2010 Pharmacists Mutual Ins. Co.

Risk Management & Patient Care

“What did your doctor tell you this was for?”

“What are your allergies?”

“What other medication are you taking?”

“What possible side-effects did the doctor go over with you?”

© 2010 Pharmacists Mutual Ins. Co.

Pharmacist Only Questions

Why does my medication look different this time?

Why are the directions different from those my doctor told me?

Are you sure you spelled my doctor’s name correctly?

If I’m allergic to aspirin can I take this?

© 2010 Pharmacists Mutual Ins. Co.

The Problem with Telephoned Rx Dr.. meant Lidex . . . . . . the pharmacist heard

and filled the prescription with . . .

Rxpatient: John -------------

Efudex 1 tubeSig: Apply ut dic

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The Telephone Rx

“Echo & Verify”

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Telephone RxPatient: Betty Smith

Penicillin VK 250 mg# 30Sig: i tid

Dr. Smithby Nancy,

RN

Telephone RxPatient: Betty Smith

Penicillin VK 250 mg# 30Sig: i tid

Dr. Smithby Nancy,

RN

Telephone Prescriptions

V10/22/04drm

© 2010 Pharmacists Mutual Ins. Co.

2 Dosage Unit Rule

Technicians cannot know usual dose of every drug

Typical prescriptions do not need more than 2 units to deliver the dose

Sigs with 3 or more units should be flagged for R.Ph. review

© 2010 Pharmacists Mutual Ins. Co.

"Mark It"

Identify those prescription items causing "problems"

Place colored tape on that part of the shelf

To cause "a second thought"

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If You Didn’t Document It, It Wasn’t Done.

but …Where?When?What?

© 2010 Pharmacists Mutual Ins. Co.

What NOT to do ...Excerpt from letter from

patient's attorney to pharmacy . . .

"As you are already aware Mrs..... _________ attempted to contact you regarding this error and was told, 'If you aren't dead, don't worry about it."

The patient immediately hired a lawyer.