Lec 4: Pharmacists' Legal Duty and Risk Management Flashcards
Pharmacists Mutual - general information
- Founded by a pharmacist Al Falkenhainer because his pharmacy burned down
- Pharmacies were stocked with organic
chemicals, used Bunsen burners and had gas lights (no electricity) - He was not satisfied with how the insurance claim was handled
- The company was located in the back room of his pharmacy for the first few years of the company’s existence
- The company continues to provide fire
coverage but the main focus is professional liability (malpractice) - As pharmacy practice has evolved, so too has the coverage provided by Pharmacists Mutual
Pharmacists Mutual Claims Study
1989 - 2021
- Started to gather and organize claims information
- Claims come from many different practice sites: Independent, chain, hospital, compounding, and long-term care
- Database contains > 14,000 records
- Average 1-2 claims per day, every day of the year
- Claims are primarily divided into two categories: Mechanical Errors, Intellectual Errors
Types of Errors in the Claim Study: Mechanical
Mechanical – wrong drug, strength or directions, also illegible handwriting, CPOE,
and distractions (~82%)
Types of Errors in the Claim Study: Intellectual
PHARMACISTS MUTUAL CLAIMS STUDY: what is the most common errors?
Medication Errors: 83% of claims come from Mechanical Errors (wrong: drug, strength, or directions) - what are some factors that can lead to mechanical errors?
Main Cause Behind Mechanical Errors
- The way human beings process information
-EVERYONE makes these errors - Valedictorian or bottom of their class
- Pharmacist, technician, or a random person off the street
-We are humans who must process information from the outside world so errors will always exist as long as humans are present.
-Ex: look alike sound alike !
Compounding Claims (3.2% of claims)
In terms of severity, compounding claims are more than ten times costlier than non- compounding drug claims. The average severity for compounding claims from 2014-2016 was $188,849 and the average severity for non-compounding claims was $12,731. Severity was calculated based on average loss per claim. No expenses were included. Also of
note, there were only 32 compounding claims in this period versus 582 for non-compounding
.
V costly because you make patches and you make lots of stuff so you might hurt a lot of people!!! That’s why compounding claims are typically v expensive. Med error in one batch can effect so many people!!!
Medication Errors
Intellectual Errors: Errors made based on a decision made by the pharmacist - What can lead to intellectual errors ?
Drug administration are the highest claims in this area!
Drugs Commonly Involved in Claims
Three factors influence a drug’s inclusion on the list:
1.) Volume dispensed - the more you dispense the more issue it can cause!
2.) Narrow Therapeutic Index (NTI) - warfarin is #1!
3.) Variety of dosage forms and/or strengths available
Pharmacists Mutual Claims Study
Drugs Delivered in Mechanical Claims 1996-2021: drugs that causes the most issue/ lead to most claims?
Controlling the Environment The Risk Management Process: 4 step process
- Identify the Risk
- Select the Technique
- Implement the Technique
- Monitor and make necessary changes
.
NOTE: we want to try to mange risk as best as we can to limit the number of risk!! WE must follow these 4 steps!
- Identify the Risk You must understand the
problem to solve it! Look at what causes claims against Pharmacists.
.
CASE #2 9 Year-Old Child Rx: Cortisporin Opth. Filled with Cortisporin Otic. How do they happen, how to prevent them?…What Factors Contributed to this Error?
First, what can we learn from this example?
Do you know what the difference is between the ophthalmic and otic versions of Cortisporin? (NOTE: the pH is the main difference!) Similar, easily confused names
The packaging is almost identical… Placement on the pharmacy shelves next to each other due to the alphabetical arrangement of
inventory. How the products are described in the pharmacy’s computer system
.
Second, we can learn how random and chaotic circumstances can become. Once a patient leaves the pharmacy with the wrong
medication, we no longer have any control over what happens. Patients will do crazy and unimaginable things with the drugs that they receive from the pharmacy. Patients will take whatever we send home with them. Another thing to consider is that this claim has NEVER been reported in the reverse (that is, eye
drop in the ear).
- Select the Technique
If mechanical errors are the major problem, where do we start?
Triple Check Plus Two- Check Three Times
Plus 1: Check NDC Numbers (The computer is not always right)
Plus 2: “Show & Tell” Counseling Never deliver a prescription “in a bag”
The importance of patient counseling and what to counsel patients on?
-“What did your doctor tell you this was for?”
-“What are your allergies?”
-“What other medications are you taking?”
-“What possible side-effects did the doctor go over with you?”
NOTE: v important to talk with patients to make sure they have all the knowledge so they can safely take their medications.
.
The Indian Health Service Patient Method
is the Gold Standard:
1) “What did your doctor tell you this medication was for?” (NOTE: important cuz some drugs have multiple indications. you need to know what it is for so you can counsel them properly)
2) “How did your doctor tell you to take this
medication?” (to double check their order to make sure what their doctors say)
3) “What did your doctor tell you to expect from this medication?”
.
-Very effective way to manage risk
-To be successful the pharmacist MUST TALK to the patient
- Patients don’t know what they don’t know
- DO NOT assume the patient knows or understands anything
Documentation: Documentation is very important in today’s pharmacy practice. If an error does occur a patient may not file suit for years
.
Statute of Limitations?
NOTE: No documentation? it did not happen! So you need to document everything!
The Telephoned Rx “Echo & Verify”
If over the phone? look for and check off the important one!
Case #3: just read it and the importance of 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 pharmacist review
Case #4: Just read it and importance of “Mark It”
“Mark It” Identify those prescription items causing “problems”!
1. Place colored tape on that part of the shelf
2. Use bins
-Cause “a second thought”
Step 3: Implement the Technique: A planned workflow every time… Who does What and Why? Workflow includes:
Case #5: Just read it
- Monitor and Make Necessary Changes
* How are we doing?
* Are we improving?
* If not, change!
Quick Insurance Lesson: Pharmacy Professional Liability is generally available in two layers
Quick Insurance Lesson: individual pharmacist professional liability policy
Pharmacy Professional Liability Insurance
You need to get your own liability policy! Cannot trust that your employer will defend you. It will also follow you from job to job! So carry your own liability policy!
