After working in pharmacy research since 9th grade and graduating in 1989 from pharmacy school at Florida A&M University of Pharmacy and Pharmaceutical Sciences, I worked as a pharmacist throughout law school and afterwards as I built my law practice. Although my law practice has required my full work attention for many years, pharmacy remains a jealous profession, reminding me that it was my first. I maintain my license to practice pharmacy. As such, I continue active pharmacy education and legislative insights as new laws affects the profession and practice of pharmacy, and impact clients and our community. I am proud to be a Florida Pharmacist and Lawyer.
Pharmacists are in the business of helping and healing people. The academic and practicum training lends itself to the pharmacy oath:
“I promise to devote myself to a lifetime of service to others through the profession of pharmacy.”
In fulfilling this vow:
- I will consider the welfare of humanity and relief of suffering my primary concerns.
- I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.
- I will respect and protect all personal and health information entrusted to me.
- I will accept the lifelong obligation to improve my professional knowledge and competence.
- I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct.
- I will embrace and advocate changes that improve patient care.
- I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.”
Why Pharmacy Errors Occur
As population and tourism continue to increase, similarly-named drugs with similar colors continue to get produced, and demands on the pharmacist continue to increase, there are going to be prescription drug errors.
Whether in a hospital or retail setting, most prescription medication errors are caught and corrected before injury occurs.
There are harmful effects of pharmacy negligence which are either serious or fatal because of the drug or health consequences from using the wrong medication.
Pharmacy negligence and prescription drug errors are usually preventable with the implementation of appropriate safety procedures, some basic precautions and the application of reasonable care.
Common medical malpractice
Several different scenarios can be considered examples of medical malpractice. They include:
Sometimes a doctor fails to recognize and diagnose a condition when a competent doctor would have spotted it. This misdiagnosis may result in the condition progressing to a more advanced stage, which may require more significant treatment and cause the patient greater pain and suffering. In the case of a serious condition like cancer, an inaccurate or late diagnosis may result in the patient’s death. A plaintiff bringing this type of claim would need to introduce expert testimony from a doctor who can explain why a competent doctor treating a similar patient would have correctly diagnosed the condition or diagnosed it sooner. An expert also would need to explain the effect of the error or delay on the patient’s health.
Many of the most obvious incidents of malpractice occur during surgical procedures. Some types of surgical errors are known as “never events,” which means that the medical profession acknowledges that these errors should never occur. A patient may not need expert testimony in these cases because the negligence is obvious. Perhaps the most common example of a never event is leaving a sponge or another surgical instrument in the patient’s body. A doctor also may operate on the wrong patient or the wrong body part, or they may carelessly injure another part of the patient’s body during the procedure. Infections and complications after surgery also can cause significant harm if they are not competently treated.
Anesthesia is a key part of the surgical process that is often taken for granted but should not be. Mistakes by an anesthesiologist can cause devastating consequences, including brain injuries and death. An anesthesiologist may fail to review a patient’s records for possible risk factors, fail to provide the patient with proper instructions before the procedure, provide the wrong amount of anesthesia, or fail to monitor the patient’s vital signs while administering anesthesia. In some cases, the equipment used to administer anesthesia is defective, which may mean that the patient can bring a claim against the manufacturer of the equipment.
Doctors, nurses, and other medical professionals can be held accountable for an error in prescribing or providing medication. The doctor probably will be liable if a mistake happens during the prescription process, while the nurse and the hospital that employs them likely will be liable for a mistake during administration. Sometimes prescription mistakes are connected to a misdiagnosis, since a doctor may prescribe medication for an incorrectly diagnosed condition. In other cases, a doctor may prescribe the wrong amount of medication, or a nurse may administer the wrong amount. A nurse also may confuse patients and give medication to one patient that was intended for another patient. Or the equipment in the hospital may be defective and administer an improper dose.
Gynecologists, obstetricians, and other medical professionals involved in the childbirth process can cause lifelong harm to newborns by failing to meet the professional standard of care. Conditions that may result from malpractice (but often have innocent causes) include cerebral palsy, paralysis, nerve damage, developmental disorders, and fractures, among others. Sometimes inadequate treatment or care prior to childbirth can cause harm to the mother and the child. For example, a birth injury might involve a failure to diagnose a medical condition or a birth defect. In other situations, birth injuries might arise from errors during the delivery process. A physician might fail to order a cesarean section when it is necessary, fail to handle complications in a competent manner, or fail to properly use equipment like forceps.
Strategies for Minimizing Pharmacy negligence include:
Transcription errors (eg, omissions, inaccuracies) account for ~15% of all dispensing errors.6 These errors can be reduced by consistently using reliable methods to verify patient identity while entering the prescription into the computer. The Joint Commission requires that at least 2 patient identifiers be used for administering medications in a hospital setting. This strategy helps prevent medication errors due to sound-alike, look-alike names. At this point in the process, it is also useful to have information about the patient, such as the age of the patient, allergies, concomitant medications, contraindications, therapeutic duplications, and the like.
Pharmacists’ “second guessing” of illegible and/or ambiguous prescriptions, nonstandard abbreviations, acronyms, decimals, and call-in prescriptions are frequently associated with medication errors.6 Whenever in question, it is important to call the prescriber to clarify any uncertainties or doubts regarding the prescription. Clarification obtained from the physician should be promptly documented. All verbal prescriptions should be immediately transcribed to a blank prescription pad and read back to the caller to ensure that the prescription has been transcribed correctly.
Similar drug names account for one third of medication errors. These types of errors are attributed to confirmation bias7—a tendency to interpret information in a way that confirms one’s preconceptions and avoids information and interpretations that contradict prior beliefs. As an example, a new, unfamiliar drug may be read as an older, more familiar one. Some of these errors can be fatal (eg, prescribing methadone instead of methylphenidate to an 8-year-old child). Such errors can be reduced by placing reminders on the stock bottle or in the computer system to alert staff about these commonly confused drug names.
Misplaced zeros, decimal points, and faulty units are common causes of medication errors due to misinterpretation. 10 A transcription or interpretation error involving a zero or a decimal point means that the patient may receive at least 10 times more medication than indicated, which can result in serious consequences (eg, levothyroxine, warfarin). 11 These errors may be prevented by using computer alerts or by stocking a single strength of the medication in the pharmacy. These errors may be detected when reviewing the label directions during patient counseling. The Institute for Safe Medication Practices (ISMP) offers a list of error-prone abbreviations, symbols, and dose designations (a brief list of common dispensing errors is given in the Table). Being familiar with this type of information may also help prevent dispensing errors.
Organizing work space, work environment, and workflow has been shown to markedly reduce dispensing errors. Proper lighting, adequate counter space, and comfortable temperature and humidity can help facilitate a smooth flow from one task to the next, thus reducing the chances of dispensing errors.11 Developing a routine for entering, filling, and checking prescriptions will help in organizing the flow of work. In addition, working with one drug product at a time and affixing the label to the patient’s prescription container before working on the next prescription will help prevent mix-ups. It is also important not to leave any drug containers unlabeled.
Multitasking and distraction during work is the leading cause of dispensing errors.2 Automatic-refill requests can reduce some of the distractions and thereby reduce dispensing errors. Also, having pharmacy technicians assist the pharmacists by performing routine functions will help minimize distractions. Although the extent to which distraction at work contributes to cognitive error is unclear, recent studies suggest that perception of dispensing errors by pharmacists is influenced by factors such as design of workflow, window services, and automatic dispensing.3 It must therefore be the goal of each pharmacy to improve the internal environment, even at the cost of patient convenience, in order to reduce medication errors.
Workload increase is often cited as a contributing factor in dispensing errors.13 Sufficient staffing and appropriate workload will help reduce errors. Regular breaks and time off for meal breaks may help reduce some of the dispensing errors. Sharing responsibilities by clearly assigning duties to the staff will help them understand the expectations of the flow of work and may ultimately aid in reducing workplace stress, and, therefore, reduce medication errors.
One way to avoid mix-ups among lookalike drugs is to store them away from each other in the medication storage area. Medication bottles should be properly organized with labels facing forward. It is also a good idea to routinely check all medications on the shelves and discard any expired medications. Use of storage bins, cabinets, or drawers can result in misplacement of look-alike drugs. It is also advisable to lock up or sequester drugs with high potential of causing errors.
Repeated checking and counterchecking is an important strategy to minimize dispensing errors. Comparing the written prescription with the product that appears in the computer, with the label being printed, and with the medication that is being filled will help reduce errors. Confirmation bias and preconceived notions makes self-checking a poor method to reduce errors. Whenever possible, it is advisable to have the rechecking done by another person, typically a pharmacist. If this is not possible, delayed self-checking rather than continuous self-checking is an alternate strategy. 14 A delayed verification will allow the pharmacist to study the prescription from a fresh perspective, which will help in identifying the error that may not have caught his/her attention the first time the prescription was handled.
Approximately 83% of errors are discovered during counseling and are corrected before the patient leaves the pharmacy.15 Therefore, it is important to go beyond offering to counsel and provide counseling for each patient. It is considered good practice to open the container and show the actual medication to the patient during counseling rather than deliver it to the patient in a sealed bag. Completing this process will provide an opportunity for the patient to see the medication and ask questions if it looks different from what he or she has been taking.11 Counseling should also include the instructions on how to take the medication and appropriate route of administration. Many dispensing errors are attributed to misunderstood directions for use.11 Educating patients about safe and effective use of their medication promotes patient involvement in their health care, which will likely reduce medication errors.
Medical malpractice is a form of professional negligence that can lead to patient injury or death. Because this type of negligence can lead to severe outcomes, it is considered a serious offense in the eyes of the law in the United States.
People who believe they experienced negligence (or their families in the case of wrongful death) can file a medical malpractice claim against the healthcare providers and facilities they find at fault as a way to cover damages and cover future costs of care due. Still, it can be challenging to prove in a court of law in some cases.
Because of that, gathering the correct information and finding the right legal team are the best ways to build a strong case against a healthcare provider who acted in a negligent manner during your care.
My staff and I are committed to holding pharmacies and pharmacists accountable for harm that they caused to a patient/consumer. Legal accountability helps to reduce the overall incidence of pharmacy errors and negligence. When a pharmacy error occurs, contact pharmacist and attorney Salesia Smith-Gordon in West Palm Beach at 561-655-9279, an experienced Florida pharmacy negligence attorney.
