What are the risk management strategies in pharmacy?
Abstract risk management strategies in pharmacy Part 1: Deconstructing Dispensing Errors James O’Donnell, PharmD and F. Randy Vogenberg, RPh, PhD Author information Copyright and License information PMC Disclaimer A comprehensive analysis of risk management strategies in pharmacy experience from a professional liability insurer, Healthcare Providers Service Organization, can help P&T committees better understand the risks and challenges they encounter each day. The insurance giant CNA, through its professional liability insurance partner Healthcare Providers Service Organization (HPSO), recently released “2013 Pharmacist Liability,” a comprehensive analysis of claims experience. This report, which looks at 10 years of closed claims, details rates of dispensing and other errors as well as injuries and adverse outcomes associated with these claims.1 An article on pharmacy-related professional liability risk exposures, based on an insurance company’s claims analysis? Why does a P&T committee member need this information? Because, by examining practices that lead to malpractice claims and economic losses, P&T committees can better understand the risk management strategies in pharmacy and the challenges they encounter daily. Could you imagine watching a news story reporting that a 5-year-old “nearly died” from taking a toxic prescription drug your organization erroneously gave to him? In this real-life case, the prescription was intended for an adult with the same name.2 This case involved a community pharmacy, but similar errors have occurred in hospitals. It could have been your hospital, with a different patient, a different drug, or a different set of circumstances. Aside from the devastating effects on the patient and family, what consequences could a situation like this have on the institution or corporation? This two-part review should be of critical interest not only to P&T committee members and pharmacists, but also to healthcare professionals in other departments, such as medical, nursing, and administration. Pharmacists are not the only professionals involved with medication dispensing, so it is important to take into account the experiences of other fields, such as nursing when considering health-system risk management strategies in pharmacy. Drug errors in an institution are usually the result of systems failure, not just pharmacy failure. This article will review the findings of the CNA/HPSO claims study, as well as two similar claims studies in allied health professions. In part 2, next month, we will discuss preventive steps that a P&T committee, pharmacy, or health institution or system can take to minimize legal risks for medication-related errors, patient injury, and malpractice suits. CNA/HPSO PHARMACIST LIABILITY STUDY The CNA/HPSO pharmacist report discusses the circumstances leading to liability claims, examines patterns of liability, and reports financial outcomes stemming from settlements and jury verdicts. The study also reports the costs of defending pharmacists before boards of pharmacy.1 The report contains several detailed case studies and high-level risk management strategies in pharmacy recommendations, which, if implemented, may facilitate medication safety and minimize the likelihood of patient injuries and pharmacist liability exposure. A self-assessment checklist is intended to help pharmacists improve their own risk awareness and safety practices. HPSO insures approximately 70,000 pharmacists who work in a variety of practice sites, including community, hospital, infusion center, long-term care, and compounding pharmacies. Over the study period (2002–2011), there were 1,409 reported medication-related incidents, adverse patient outcomes, and actual claims against pharmacists, pharmacy technicians, and other pharmacy personnel and entities insured through CNA/HPSO. Claims that were closed during the study period and that resulted in an indemnity payment of $1 or more were included in the dataset (N = 162). The vast majority—93.8%—of claims analyzed involved pharmacists with individual professional liability policies, while 5.6% involved pharmacists employed by a corporate entity. Only one claim involved a lawsuit against a pharmacy technician. In all, closed claims resulted in payments totaling more than $14 million over the study period.1 CNA/HPSO grouped claims into National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) categories. Three of the 10 categories resulted in a higher-than-average paid indemnity, accounting for only 32.7% of all claims but 82.9% of all dollars paid (Table 1). Table 1 Medication-Error Claims, by National Coordinating Council for Medication Error Reporting and Prevention Category1 NCC MERP Category % of All Claims % of All Money Paid Notable Cases Permanent patient harm 11.7% 41.1% Infant born at 23 weeks when Prostin was dispensed to the mother instead of progesterone Child suffered brain damage after receiving improperly compounded total parenteral nutrition Adult suffered brain damage after simultaneous overdoses of Phenergan and fentanyl Patient death 11.7% 29.6% Clonidine compounding error in a child Dispensing of wrong drug resulted in a child not receiving chemotherapy for leukemia Adult given intrathecal morphine Intervention to sustain patient’s life 9.3% 12.2% Wrong dose of fentanyl resulted in respiratory arrest, resuscitation, and permanent brain damage Wrong dose of tacrolimus led to failure of the patient’s transplanted liver and necessitated a second liver transplant The use of a brand name in tables is intentional because this is a closed-claim study. Generic names are used where no specific brand name was indicated. The report also identified the categories of errors and omissions that are most responsible for malpractice claims against pharmacists. Wrong drugs (43.8%) and wrong doses (31.5%) represent more than three-quarters of all closed claims reported (Figure 1).
