Drug Topics - October 6, 2008 - (Page 3) www.drugtopics.com Oct. 6, 2008 DRUG TOPICS 3 REDUCING YOUR RISK Ken Baker, B.S. Pharm., J.D. Medication errors: What to do when you make an error Can I apologize? fter more than 30 years, I still remember the feeling in the pit of my stomach when I received the phone call from one of my patients telling me I made an error with her son’s prescription. It was certaintly not the only mistake I made while practicing pharmacy, but it is the one that I remember most vividely. Luckily, there was no harm done as the mother had noticed it before she gave the first dose to the boy. In those days I knew only a few things to do when I learned of a medication error — appologize profusly, correct the mistake and get the right prescription to my patient as quickly as possible. Those things are still the first and most basic steps to take when an error is discovered. Today, I know that when you make an error, there are more things to be done after those basic steps are taken. I also know now there are some things you should not do. Those basic steps are still important. If you make an obvious error, an apology is in order and should be genuine. Some pharmacists are concerned that an apology may invalidate their professional liability policy. Check with your agent to be certain, but the following clause is a familiar one from the Pharmacists Mutual individual professional liability policy [PM PHL 196 (8/02)] You shall not, except at your own cost: a) voluntarily make any payments; b) assume any obligations; c) incur any expense; or d) make any admission of liability. Pharmacists Mutual has defined an apology for making a mistake as NOT amounting to “any admission of liability.” An admission of liability is taking responsibility for the results of the error. So, while a pharmacist may say, “I am sorry we made a mistake,” he or she should not say, “our mistake is what caused your injuries.” The first is an apology; the second is an admission of liability. Note in the insurance language above the first three items under, “You shall not, except at your own cost.” When you discover an obvious error, you should not make a payment, assume an obligation or incur any expense. Later, in this article, we will discuss an exception to that rule, but it is a narrow exception, as you will see. A Even if an error is obvious and even if there is a real injury, avoid the temptation to do more than you can do at the time. You can tell the patient that you will submit bills, requests or demands to the insurance company or to a supervisor, but you cannot admit the injury was caused by the mistake; pay expenses yourself nor pay any money out of the cash register or your pocket. The limited exception to the rule that the pharmacy should not pay expenses is found in a special coverage under most commercial insurance policies called “Med Pay.” This coverage is generally not found in pharmacists’ individual policies, but is usually provided under the pharmacy’s policy. One standard Business Owners Policy (AAIS PB 0200 ©2002 – emphasis added by author) defines its Med Pay Coverage as: a. “We” [insurance company] pay the medical expenses described below for “bodily injury” caused by an accident: 1) on premises “you” [pharmacy] own or rent; 2) on ways adjacent or next to premises “you” own or rent; or 3) because of “your” [pharmacy’s] operations. b. “We” pay these medical expenses regardless of fault but only if . . .. Med Pay provides only a limited amount of coverage; usually less than five thousand dollars, but it is “regardless of fault.” It is only for medical expenses, not for pain or suffering or in settlement of a claim. The pharmacy, not the pharmacist, may invoke its Med Pay coverage to pay for an ambulance and a doctor’s visit, for example. While it is usually used in the event of a “slip and fall” injury, it may also be available for a patient injured by a medication error given by the pharmacy to the patient by mistake. This article does not constitute legal or consultative risk management advice. You should not rely on the information here or in any similar article for a plan of quality or for legal matters. Consult a risk management consultant or an attorney. Ken Baker is a pharmacist and an attorney. Baker practices law as an attorney, of counsel, with the Arizona law firm of Renaud Cook Drury Mesaros, Pa. He also consults in the areas of pharmacy error reduction and risk management. For questions or citation and footnotes, contact Ken Baker at ken@kenbakerconsulting.com. http://www.drugtopics.com
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