Medication errors haven’t gone away


A 10-year analysis of medical malpractice cases indicates that medication errors continue to represent a significant risk to patients and health care providers, despite myriad efforts to eliminate that risk. For events that occurred beginning in 2003 (12 percent) to those from 2012 (12 percent) the proportion of cases alleging a medication error was, essentially, unchanged. Raised awareness, advances in technology, and millions of dollars directed at improving the medication process, have not yet initiated a downward trend. But that does not mean that nothing has changed: patients now encounter fewer errors in the more mechanical, ordering/dispensing/administering steps of the medication process, and significantly more risk in the clinical judgment/communication aspects of monitoring and managing their medication regimens

The annual volume of inpatient drug orders and outpatient prescriptions is in the billions; more than 100 million Americans take four or more medications regularly. From beginning to end, the medication process is a malpractice minefield for providers all across the field of health care. Given those big prescription figures, the raw number of malpractice cases is relatively small: physicians and nurses (and patients) mostly get it right. But, within the realm of malpractice, medication-related events often represent an extreme breakdown in the standard of care and — most often — the patient at the center of such cases has suffered a significant injury (17 percent), or died (32 percent).

In between getting everything right and having something go terribly wrong, it is fair to assume that patients and providers are encountering a vast array of medication-related errors. Many play out as near misses, and even most of those that do result in adverse events will not trigger a lawsuit. But all medication errors have some short or long-term consequences for patients and providers: adding cost, eroding trust, instilling uncertainty about caregivers and the systems on which they rely.

Our study found that three medication categories (analgesics, anticoagulants, and antibiotics) account for almost half (48 percent) of all medication-related malpractice cases, and 37 percent of those cases in which the breakdown occurred during medication monitoring and management.

Across all care settings, clinicians who order medications establish expectations about efficacy and safety. New prescriptions may demand sharper attention than renewals; high-risk drugs require extra surveillance; but all medication orders imply a commitment to monitoring and managing the immediate and long-term effects. As was seen frequently in our analysis, even greater vigilance is necessary for patients with challenging comorbidities and unresolved health issues, and a low tolerance for drug-related complications.

Of course, many patients receive care in multiple settings, and rely on multiple providers to monitor a range of health issues. All too often, they are left to manage their medications on their own … with unfortunate consequences. Even fully competent and adherent patients require consistent support to monitor the effects of their medications and manage complications or diversions from routine use. At every step of the medication process, patient information and clinical decisions have to be coordinated with other caregivers — professionals and family members. Often, such communication is intermittent, one-directional, or strictly electronic. If multiple individuals are managing a patient’s multiple medications, then the medication process becomes more complex for everyone. A commitment to two-way communication and coordination is essential to preventing medication errors, patient harm, and allegations of malpractice.

Jock Hoffman is senior editor, patient safety, CRICO, which can be followed on Twitter @cricotweet.

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