EXECUTIVE SUMMARY

Recent research indicates that opioid-related claims are among the most common malpractice claims. Many medication errors occur in a clinic or physician office.

• Anticoagulants were involved in 16% of medication error cases.

• Inadequate monitoring also was cited frequently.

• More than one-third of medication error cases involve a patient death.


Opioids were the leading drug associated with medication-related malpractice claims, according to recent research from Boston-based medical liability insurer Coverys. The second most common claim was anticoagulants. Coverys calls this the “dangerous duo” for medication errors and liability.

A recent report from Coverys analyzed more than 10,000 closed medical professional liability claims from 2012 to 2016 to determine the causes of medication error and how to prevent it. (The full report is available online at: http://bit.ly/2gkcMrT.)

Key findings include the following:

  • Opioids are involved in more medication-related claims than any other drug, followed by anticoagulants. Twenty-four percent of medication-related claims involved opioids, while 16% concerned anticoagulation drugs;
  • 42% of medication errors occur in an office or clinic setting;
  • 31% of medication errors are related to inadequate monitoring of a patient’s medication regimen;
  • 38% of medication error cases ultimately involve a patient death.

Claims about alleged issues with administration of medications represent 31% of all medication-related claims and are the third highest process issue for providers, notes Robert Hanscom, JD, vice president of business analytics with Coverys.

The report notes that “When verifying instructions, preparing or measuring a dose, or physically administering a dose of medication to a patient (or when patients take the medications themselves), much can go wrong. Our data show a slight rise in the incidence of these issues — 28% of such cases resulted in indemnity paid.”

Hanscom says the continuing prevalence of medication errors and medication-related claims is surprising.

“We actually thought we would have made more progress with medication-related malpractice cases from 10 or 15 years ago with the promise of what electronic medical records would do for us,” Hanscom says. “We hoped that the process-based components of that technology would almost cure these kinds of errors, but they are still with us. We’ve made a lot of process in some of the process-based vulnerabilities out there, like the dispensing and administration of drugs.”

There still are issues related to ordering medications, which includes evaluating the patient and providing the right drug treatment, Hanscom says. That is where the opioid epidemic ties into the ongoing number of medication-related malpractice cases, he says.

“Opioids are special medications and there is never the intent for the patient to stay on them for long periods of time, but that’s what we’re seeing with so many patients. And there is the question of whether some patients should ever have been on opioids in the first place,” Hanscom says. “Those are the elements we’re seeing at play in some of these very bad malpractice cases.”

Coverys advises managing the “Five Rights” during medication administration: right patient, right drug, right dose, right route, and right time.

“According to our data, monitoring and managing a patient’s medications is the second riskiest step in the medication episode of care, resulting in more than 31% of medication-related claims,” according to the report. “Evidence indicates that a lack of vigilance in medication reconciliation can contribute to an adverse event. While technologies have significantly improved the selection, dispensing, and administration of medications, the work of medication reconciliation is an ongoing challenge.”

Medication monitoring and reconciliation — ensuring that the full collection of various medications any given patient is taking are still safe, necessary, and appropriately dosed — requires “impeccable processes and clear communication as patients move across the continuum of care and ongoing medication adjustments are made,” the report says.

Anticoagulants are a common problem, Hanscom notes. Patients on blood thinners must discontinue them before elective surgery, but may not resume the regimen properly, he notes.

“Things get lost in the system and confusion is created about what medication the patient should resume after, and when they should resume. They may not even be put back on the medication and no one notices until there is a bad outcome,” Hanscom says. “This can happen when you have many providers involved and many medications, and no one is clear on who is in charge. This is a problem that has been worrisome for us and has not really gotten any better over a period of time.”

Coverys notes that the healthcare industry has focused more on medication reconciliation, but with many patients seeing many doctors in different systems and with multiple medications, it can be hard to keep up.

“Sometimes patients are not well aware of all the medications that have been prescribed to them and go on new ones at each physician visit. At the monitoring and management stage, communication is key. It’s important to discuss how a medication is working, whether the patient is having any side effects or adverse reactions, and — over the long term — to reassess whether the medication is still the right choice, taking into consideration other medications the patient is taking and/or new symptoms or conditions,” the report says. “We suggest the slightest mention of a side effect be documented in the patient’s medical record and that providers find reliable ways to get patients to comply with medication reconciliation processes. There are dozens of mobile apps patients can use to keep track of their medications, or they can use paper ‘medication cards’ that are regularly updated.”

SOURCE

  • Robert Hanscom, JD, Vice President, Business Analytics, Coverys, Boston. Phone: (800) 224-6168.