Medication Errors Result in Injury and Death

MagMutual, a leading healthcare liability insurer of physicians and surgeons, reports that  “[m]edication errors account for 8% of medical malpractice claims among family practitioners insured by MagMutual. It is estimated that about 50% of medication errors are due to ordering issues, including wrong medication, wrong dose or wrong route.”

The company reports that

[t]he main causes of claims related to medication errors are:

• • Failure to Assess Lab/Vital Results
  • Failure to Administer Proper Antibiotics Based on Culture Results
  • Patient Monitoring Problem
  • Provider-to-Patient Communication

This is what the company identifies as the “top strategies for reduction” of risk:

Based on these top risk drivers, implementing the following clinical and operational strategies can help you prevent unexpected outcomes and increase defensibility of a medical malpractice claim:

Clinical strategies

• • Discuss and document the high-risk side effects of every new medication. Include the reason why the medication is being recommended, how to monitor for signs of an adverse reaction or toxicity, and what to do if symptoms of potentially dangerous reactions develop.
  • Schedule appropriate monitoring diagnostic studies when starting a new medication. Examples include Lasix and interval basic metabolic panel, and Warfarin and scheduling CBC to accompany INR check, especially when first starting the medication.
  • At every appointment, review patient allergies (or side effects) and all medications (both prescribed and over-the-counter). You or clinical staff could document “medications reconciled” after reviewing all medications.
  • When refills come in electronically or telephonically, consider documenting ‘make appointment or needs labs’ to the prescription that is electronically prescribed.”

Operational strategies

• • For more commonly prescribed medications, create a patient education handout for possible side effects, concerning reactions, monitoring instructions and what to do if side effects or reactions occur.
  • Develop clinic protocol for double-checking medication and dosing when it is prescribed or called into a pharmacy. Discourage verbal orders or phone-in prescriptions when possible.
  • At every appointment, review patient allergies (or side effects) and all medications (both prescribed and over-the-counter).
  • Develop instruction sheets for patients, outlining a plan for holding and restarting anticoagulation. Sometimes the date to restart the medication is unclear, but the patient should understand the plan is to restart the medication when it is safe. When it is based on the surgeon’s recommendation after a procedure, make sure the patient knows to clarify the plan with the surgeon when being discharged from the hospital or surgical center. When it is based on a medical condition (like GI bleed), make sure the patient knows to clarify this with the treating physician. A CHADS2 VACS score should be calculated and used in conjunction with ACC guidelines to provide clear decision-making regarding the appropriate use of anticoagulation.
  • Opioid prescribing involves conducting a thorough evaluation of the patient’s medical history, including any previous substance abuse issues or risk factors for addiction, screening for high-risk sedative hypnotic medication and alcohol use, as well as using prescription drug monitoring programs to identify potential misuse. Additionally, healthcare providers should prescribe the lowest effective dose for the shortest duration necessary, provide education on the risks and side effects of opioids, and explore non-opioid alternatives or multimodal pain management strategies whenever possible. Be aware of the federal and state laws surrounding opioid prescribing for acute pain management.

Patients, doctors, and MagMutual benefit from MagMutual’s efforts to educate doctors on how to avoid claims.  Patients benefit because the risk of injury or death is reduced.  Doctors benefit because more knowledge and adoption of best practices can reduce errors and therefore harm to patients, which in turn results in less emotional turmoil for doctors.  And MagMutual benefits because reduced claims result in reduced claim and defense cost payments.

The Law Offices of John Day, P.C. has represented people injured by medication errors for over thirty years.  In fact, my first medical malpractice trial (when I was two years out of law school) involved a woman who went blind because of the failure to adequately monitor a patient who was prescribed a drug (myambutol) to treat tuberculosis.  Questions?  Email me at jday@johndaylegal.com or call me at 615.742.4880 for a free consultation.