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What Do Pharmacists Do When the Unthinkable Happens?

Tuesday, September 2 2014 Submitted by Pharmacists Mutual

By Ken Baker, R.Ph., J.D.
Consultant for Pharmacists Mutual Insurance Co.

Every pharmacist knows they can and do make mistakes. If we have a good prescription system, we can usually catch the mistake before it reaches the patient. Eventually, if we practice long enough, one of these near misses reaches a patient and it becomes every pharmacists’ worst nightmare. What happens at that point is often a question of luck.

The patient may notice the mistake and return the prescription to the pharmacy before any of the drug is taken.

The patient may take the medication, but no harm results. For example, a prescription for an otic is mistakenly filled with an ophthalmic form of the drug. A medication error was made, but no one was injured, the patient probably got well and neither the pharmacist nor the patient ever knows a mistake was made.[1]

Too often, however, the patient takes the incorrect medication and notices the mistake only afterwards. How does the pharmacist handle the situation when a patient returns to the pharmacy alleging that the pharmacy made an error? What evidence does the pharmacist need to preserve? What can be said and what should not be said?

A conversation may seem very cordial and end on a good note. Most times the feeling that “everything went well” proves to be correct and the matter is over. Occasionally, however, the patient receives advice from other parties and the friendly exchange escalates into a claim and/or a lawsuit. The problem is you can never be certain what the future will hold, so you should document as if there will be a reason to be able to recall exactly what was said and done. Consider a few sample procedures to follow whenever an incident happens that could lead to a professional liability claim.

Protect your patient.

The first rule is take care of the patient. Whether your pharmacy made a mistake – or someone else did – your patient has a potential problem. They are probably concerned and anxious. There could be worse injuries if treatment is delayed. Find out if the patient took any of the wrong medication or if they missed any prescribed medication. Make certain they get any necessary medical help. Not only may this mitigate damages caused by the error, more importantly, your patient may need to receive treatment. Whether or not they need care is probably not your decision, but the patient’s and the prescriber’s. Even if there is no apparent injury, you need to call the prescriber so the information can be placed in the patient’s file. In McClure v. WALGREEN, the Iowa Supreme Court criticized the pharmacy for failing to warn the patient of the potential effects of the error when its employees discovered the mistake and used this failure as one of the bases of additional damages.

Ask questions.

Once all emergencies have been handled, try to find the extent of any potential problems by asking questions. Did the patient take any of the erroneous prescription medication? If so, how much did they take? When did they take it? Document the conversations with the patient or caregiver. If what was said is ever needed, any trial or deposition may be 2-3 years or later in the future. Under court rules, you can use your notes to refresh your recollection. All documentation must be truthful and accurate as your credibility will be on trial as well as the case. If possible, have a witness to the conversation initial the notes. In addition, you should retrieve any incorrect prescription to prevent any additional harm – but do not destroy it. Count the tablets and save the bottle. Treat this as evidence by placing it in an envelope and sealing it with your initials on the closure. The best place to document is on the back of the prescription, on paper stapled to the prescription or in a file folder, as long it’s easy to find later. Notes in the computer can be lost and hand written notes are more easily authenticated. Pharmacists Mutual has a documentation journal available for this purpose. You can get one or more from your Pharmacists Mutual representative or by calling the company and asking for the Pharmacists Journal.

Do not admit liability.

If you make an obvious error, you may say, “I made a mistake, I am sorry.” You may not, however, admit liability or offer to pay money or to settle the case using your own money, as one pharmacist did under pressure from an angry customer. Admitting liability is more than saying “I made a mistake.” A mistake, such as putting the wrong drug in the bottle, is a fact question. Admitting liability, such as saying “I caused your injuries,” is a legal statement. Not only would admitting liability be a possible violation of the conditions in your insurance policy, but would also probably be beyond your knowledge. The patient may have other conditions or other incidents of which you are not aware.

Show compassion.

If the error is not obvious to you or if you think you are not responsible for the mistake, you should not argue the point with the patient, but you can express sympathy for the patient. You can always say, “I’m sorry you feel bad.”

Act quickly.

When any mistake is made that could result in a claim, immediately report it to your insurance company. Your policy may have penalties for not reporting promptly.

Train your staff.

Finally, train your staff how to react if the “unthinkable” happens. A question like “Why is this tablet a different color?” should be a pharmacist only question. The pharmacist should treat every such question as an error unless and until the opposite is PROVED.

This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorney and insurance company for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly. Names used in this article have been changed and any similarity to real persons is purely coincidental.


[1] In a study at Pharmacists Mutual over a three-year study, 2% of all claims filed against pharmacists involved a prescription for an ophthalmic filled with the otic form. Never in the past 15 years, however has Pharmacist Mutual received a claim for an ophthalmic drop mistakenly given for a prescribed otic.

Finding Support During a Stressful Claims Experience

Thursday, April 17 2014 Submitted by Pharmacists Mutual

Insurance claims can cause feelings of loss, guilt, fear & frustration.

According to the Institute of Medicine, at least 1.5 million Americans suffer from preventable adverse effects due to improper use of their medications each year. That has contributed to unprecedented litigation and discipline throughout the health care industry. The National Practitioner Data Bank (NPDB) cites 565,787 counts of medical malpractice and adverse action reports from 2002-2012 – with pharmacy representing 18,737 cases.

This can be costly for business. Even though overall payment amounts decreased in 2012, there were still a total of 12,142 medical malpractice payouts – or roughly 1 payout every 43 minutes.

In short, a medical malpractice charge can happen to anyone at any time.

Professional liability and umbrella coverage can help you protect your business and financial assets. But what about the mental and emotional tolls a liability claim can take on the practitioner?

“A stressful claim or lawsuit can cause an insured to experience feelings of shame, guilt, anger and frustration. We feel that by allowing our insureds to confidentially share those feelings with a peer who has been through a similar situation, they can regain a sense of control, allowing them to function as a good defendant and a competent pharmacist during the claim process,” says Wendy L. Guthrie, Manager – Professional Liability Claims for Pharmacists Mutual.

The Pharmacists Mutual Peace of Mind Peer Support Program is a confidential, complimentary service available for our members who are experiencing or have experienced a professional liability claim.

We understand the traumatic impact a claim – particularly one alleging professional negligence – may have on your professional and personal well-being. You may feel a mix of emotions, including regret, grief, disappointment, resentment, even helplessness.

“A stressful claim or lawsuit can cause an insured to experience feelings of shame, guilt, anger and frustration.”

We’re here to help. We offer a peer support program to connect you with others who have been through a similar situation. The program is completely confidential and discreet; peers are partnered together to allow for informal conversation and emotional support, not to discuss the details or legal merits of the case.

The goal of this program is to diminish the effects of stress during the claims process, allowing you, as a professional, to regain a sense of emotional balance and control. This also enables you to function as a credible defendant and a competent practitioner during the claim or litigation process.

At some point, even the most experienced pharmacist may face a liability charge. You don’t have to go it alone.

If you or someone you know can benefit from the Peace of Mind Peer Support Program, or if you would like further information, please contact Pharmacists Mutual at 800.247.5930 ext. 4280 or email peer.support@phmic.com

Looking for ways you can help prevent a claim from happening? Check out our Risk Management Intel publications. They are filled with preventative tips, safety protocols, checklists, guidelines and much more.

Making Social Media Work for Your Business

Wednesday, November 6 2013 Submitted by Pharmacists Mutual

Social Media for Health Care ProfessionalsTwitter, Facebook, Tumblr – you may have used these platforms for keeping up with family and friends, following your favorite brands or tracking activities in the community. But have you considered the value social media can add to your business?

Today social media is more than just a way to keep people connected. It’s a highly cost-effective and easily implemented method for reaching customers – from authoring blogs on WordPress to tweeting quick tips on Twitter to sharing video on YouTube, Vine and Instagram.

What value could a social media plan have for your business? Here are a few roles social media can play:

  • Demonstrate your expertise. Bring the same level of trust your patients have in you to social media. Give advice, provide insights and share relevant content from your favorite websites.
  • Show your personality. Post behind-the-scenes photos, office happenings or words of wisdom that make you unique.
  • Connect with your patients. Ask questions and respond to their inquiries via social media channels. Social media can also be a first place to address customer service concerns.
  • Increase exposure. Each “share” or “retweet” means your name could appear in front of potential customers.
  • Improve your SEO. With each social media account, you can set up a link back to your website. The more social media profiles you have, the more opportunities for you to “own” the results on a Google search for your business.
  • Stay informed. Keep up with your peers by monitoring online conversations on industry trends or pending legislation. You may also find out what people are saying about you and your business.

Some specific tactics you may be able to apply to social media for your business:

  • Use Instagram to show equipment or office features from unique angles. For pharmacists, this may showcase the advanced services or specialized practices utilized in your pharmacy. For our dental customers, explaining what each piece of equipment does may alleviate some of the intimidation that comes from an office visit.
  • Connect with partners and vendors on LinkedIn - which is also a great place for recruiting. Share industry articles you might read online.
  • Ask fun, engaging questions on Twitter or Facebook (for example: “How much does the tooth fairy leave at your house?” or “What’s your child’s favorite flavor when they need an antibiotic?”).
  • Post patient testimonials on YouTube or Instagram.

These are just a few ideas. Check out these other great resources specifically related to social media for dental practices and pharmacies.

Are you active on social media? What have you found to be the most effective? Leave your thoughts in the comments below.

The Opioid Epidemic

Tuesday, July 23 2013 Submitted by Pharmacists Mutual

There is a persistent and growing problem in the pharmacy industry – the proliferation of opioid use and the negative downstream effects that impact healthcare outcomes and cost millions of dollars annually.

Opioids fill legitimate pain treatment needs when prescribed and dispensed responsibly. Unfortunately, for a variety of reasons, use and diversion have exploded into what is described by the Centers for Disease Control as a national epidemic. According to the 2010 National Survey on Drug Use and Health conducted by the US Department of Health and Human Services:

  • 5.1 million people use opioid pain medications in any given month.
  • Narcotic analgesics exceeded 238 million prescriptions in 2010 (nearly 2 prescriptions for every 3 residents of the U.S.)
  • Deaths from opioid analgesics now exceed deaths from both suicide and motor vehicle collisions annually.
  • More people die from opioids, the synthetic form of opiates, than from heroin and cocaine use combined.

Opioid Risk Management Newsletter

What does this mean for you? Millions of dollars in direct or indirect costs associated with the cost of pharmacy burglaries and robberies, costs to protect against theft, prescription fraud, professional liability associated with filling prescriptions, and increased workers compensation claims when employees are injured. Additional costs that can be more difficult to calculate include time spent dealing with police, the board of pharmacy, the DEA and lost business.

In a special edition of our Risk Management Newsletter, our expert risk management team explores the fundamental causes of the problem, how it adversely impacts business results, and what can be done to turn the tide. Pharmacists Mutual provides specialized insurance products for our members, but the best insurance is prevention.

For more information on the opioid epidemic and what you can do to protect your business, check out the RMNL Opioid Edition online.

Smarter, Faster, Healthier: More Mobile Apps for Pharmacies

Wednesday, June 12 2013 Submitted by Pharmacists Mutual

Last month, we brought you some of the best iPad apps for pharmacists. We also received a lot of great response about some of your favorite apps in the comments section.

This time, we’re focusing on the technology solutions from our partners at RXinsider.

RXinsider and has been a friend to pharmacists – and health care in general – for nearly 15 years. Their mission is “to develop unique, practical, and successful technologies that support healthcare practitioners throughout their continuum of practice.”

RXinsider’s solutions range from B2B, career focused, educational and more. They provide a wide range of interactive solutions, including a massive virtual pharmacy trade show, search engines and email marketing. RXinsider has also developed a number of mobile apps to help make pharmacists lives easier.

Here are just a few of RXinsider’s web-based mobile apps for pharmacies:

 

Pharmacy Platinum PagesPharmacy Platinum Pages
Check out the “Yellow Pages of Pharmacy.” Serves as a comprehensive buyer’s guide with more than 220 profiles. Browse through products & service providers in everything from insurance (where you’ll find Pharmacists Mutual!) to automation/robotics to cosmeceuticals.

 

20Ways20Ways
Read content from RXinsider’s 20Ways publication direct through your iPhone or smartphone. Filled with tips for improving patient care and your pharmacy’s financial bottom line.

 

Preceptor Development AppPreceptor Development
Find a list of continuing education (CPE) programs tailored to developing preceptor skills. Search for programs by discipline, format or provider.

 

Pharmacy Education for Long Term Care AppProfessional Development for Long-Term Care
An all-in-one app for advancing your pharmacy skills. Combines the ASCP Continuing Education App, the Preceptor Development App, and the 20Ways Publication App.

 

Do you have a favorite app from RXinsider? Or do you have any other mobile apps to add to the list? Share your thoughts in the comments below!

Error Reporting: Using One Mistake to Avoid Another

Wednesday, May 29 2013 Submitted by Pharmacists Mutual

A larger quantity bottle of clonidine recently became available. This was a common medication sold at Tom’s Pharmacy, so the larger quantity bottle was ordered. When the larger bottle arrived it did not properly fit on the shelf, so the bottle was placed on its side. Sitting on the shelf next to clonidine was clonazepam.

A prescription came in for clonazepam. In a hurry, the pharmacist grabbed what he thought to be clonazepam and filled the prescription immediately, knowing the patient was waiting.

Later, the patient called the pharmacy and said his pills “look different.” The pills were identified and the patient was instructed to return the medication to the pharmacy. An incident report was written up and placed in the pharmacy’s system. In the next couple weeks, 4 more prescriptions for clonazepam were received, filled by other pharmacy staff, and dispensed to patients. The pharmacy received calls from several patients stating their medication looks different. Incident reports for these occurrences were documented in the pharmacy system.

Finally, one of the pharmacists noticed that when they went to grab clonazepam, clonidine had rolled over into the wrong space on the shelf. It was discovered that the label for clonidine was hard to see because the bottle was on its side. The solution was easy – the shelf was moved so the larger bottle of clonidine could properly stand up.

The Pharmacists Mutual Claims Study reports that the largest category of claims against pharmacists has been “Wrong Drug.” Each year this one type of “Wrong Drug” mistake accounts for approximately 50% of all claims received by Pharmacists Mutual.

“Wrong Drug” is potentially the most dangerous error.

Many pharmacies have an incident reporting system, but very few have a quality reporting system. The difference is this:

  • Incident reports are for the insurance company to handle claims, real and potential.
  • Quality reporting, or peer review reports, are for reducing medication errors and to reduce future errors.

Most pharmacies do not systematically collect information on mistakes for the purpose of gathering from errors to improve quality. Pharmacists should not rely on reporting alone. The value of error reporting systems or incident reports are found in their ability to implement new processes. Patient safety can only improve by transforming the reported errors reported into action.

In the case with clonidine and clonazepam, the first error was not properly investigated. Each time there is a mistake – even if it does not reach the patient – you must ask “How did the error occur” and “How can we make sure this does not happen again?”

Robert M. Wachter observed: “Error reporting systems can be powerful tools when the reports are used to improve the system and educate, and they are particularly valuable when those who submit reports subsequently learn that their submissions made a difference.”

Recording of errors, however, is not enough. A quality peer review system must learn from all mistakes, or “quality related events.” We can particularly learn from our success stories – mistakes that did not reach the patient because the pharmacy’s system caught them.

No one wants to make errors. However, human beings make mistakes, and in pharmacy, some mistakes injury patients. We need to continuously improve quality and reduce medication errors. One way we accomplish this is collecting and using information. As philosopher George Santanyana wrote, “Those who cannot remember the past are condemned to repeat it.”

Top iPad Apps for Pharmacists

Thursday, May 2 2013 Submitted by Pharmacists Mutual

Your iPad can be an invaluable tool for the pharmacy. While Angry Birds and FaceTime are fun for downtime or travel, there are a number of pharmacist-specific apps available on the App Store you could be using every day at your business.

Just like your laptop, POS systems or any other form of technology, an iPad with the right apps on it can make your operation more efficient, ensure quality control and improve customer service. Here are some of the most popular iPad apps for pharmacists:

Medscape App

Medscape
Catch up on the latest news and FDA announcements. Explore drug interactions. Take advantage of quick lookup of drug information, clinical evidence, recalls and more.

 

Medibabble AppMedibabble
Allows you to translate common medical-related phrases that can help you overcome language barriers with non-English speaking customers. You can see phrases written out, as well as play audio of each phrase. (Google Translate is also a solid option.)

 

Pharmacy Times AppPharmacy Times
Get all your pharmacy news digitally, direct to your iPad. Also get access to the iPad-only Pharmacy Insights, with the latest professional news & trends.

 

Epocrates AppEpocrates
A must-have for robust drug reference needs, with brand, generic and OTC medicines. Features drug interactions check and pill ID. Relied upon by more than 50% of U.S. physicians, and is one of the apps pharmacist reviewers say they “can’t live without.” Several versions available, at different price levels.

 

MedCalcMedCalc
Pull up more than 300 relevant formulas, scores, scales and classifications. Store your most commonly used equations. The premium version even allows you to store patient results for easy referral.

 

LexicompLexicomp
Called the “most trusted and comprehensive resource for mobile drug and clinical information.” Check dosing, read guidelines, even access pictures of medications to help patients who may not remember the name of their medicine. Regularly updated with the latest drug information, so you always have the most up-to-date data. Again, multiple price points available based on your needs.

 

Enter Our iPad Giveaway

Want to start putting these apps to work for your pharmacy? Visit our Facebook Page where you can enter our “Meet the Challenge” sweepstakes for a chance to win a new iPad.

Planning for Catastrophes

Wednesday, March 13 2013 Submitted by Pharmacists Mutual

When a catastrophe occurs, not all costs can be covered by insurance premiums. For homeowners who live in areas subject to weather-related events who want to provide added protection, two states are leading the way with an innovative program.

South Carolina and Alabama currently allow individuals to establish interest-bearing savings or money market accounts to pay for weather-related catastrophes. While still subject to federal taxes, these accounts are free of state taxes, and are available for a state income taxpayer for residential property. Funds can be used to cover insurance deductibles or other uninsured portions when a loss occurs to a residence from a weather event.

Rules in both states are similar:

  • Accountholders can contribute a maximum of $2,000 if the qualified deductible is less than or equal to $1,000.
  • Accountholders can contribute an amount equal to twice the amount of your deductible, not to exceed $15,000 if the qualified deductible is greater than $1,000.
  • The account must be labeled as a catastrophe savings account, and the taxpayer may only establish one catastrophe savings account.
  • The accountholder must specify that the purpose of the account is to cover the amount of insurance deductibles and other uninsured portions of risk of loss catastrophic events.
  • In South Carolina, the rules are the same as Alabama with the exception that the storm must be declared an emergency by Executive Order of the Governor for policyholders to withdraw money.
  • Money can be withdrawn at any time.
  • If the account holder no longer owns a legal residence, then the amount withdrawn is included as taxable income.
  • If the homeowner withdraws on the account for purposes other than a qualified catastrophe expense, the expenses are subject to the state income tax at the regular rate and an additional tax of 2.5% for the year of withdrawal. (The additional 2.5% tax does not apply if you no longer own a residence, or if the taxpayer is 70 years or older and has a homeowners policy.)

Similar legislation is pending in Mississippi at the time of this writing.

Residents in Alabama, Mississippi and South Carolina are encouraged to speak to a local Pharmacists Mutual agent to learn more about the catastrophe savings account program.

For additional information, please visit:

Are You at Risk from Flooding?

Friday, March 1 2013 Submitted by Pharmacists Mutual

Be Ready with Flood InsuranceA flood can occur in every part of the country – and just because you haven’t experienced one in the past doesn’t mean you aren’t at risk. Flooding can be caused by a variety of conditions: hurricanes, rapid and heavy rainfall, outdated and/or clogged drainage systems, overtopped levees, even snow melt.

Everyone is at risk. FEMA has even created flood-hazard maps to show the different degree of risk for each community across the country. An interesting fact: 20% of all flood insurance claims are from low-risk areas.

Are you protected against flood damage? Most homeowners and businessowners policies do not contain flood coverage. Flood insurance is available to all property owners and renters in communities that participate in the National Flood Insurance Program. However, it’s important to know that there is usually a 30-day wait for coverage to become effective – unless it is required for a loan activity.

Plan ahead so you aren’t left without coverage if a disaster happens in your area. Talk with your Pharmacists Mutual representative today to make sure you’re protected.

For more information on the National Flood Insurance program and for frequently asked questions, check out the FloodSmart website.

Internet Prescription Brokers: Too Good to be True?

Friday, February 22 2013 Submitted by Pharmacists Mutual

Marty was familiar with the challenges of making a profit in pharmacy today, so when he was approached with a proposal that promised a markup on prescriptions higher than anything he had seen for several years, he was interested.

The deal sounded pretty straightforward. Prescriptions would be faxed to Marty’s pharmacy from a website. Prescriptions would be written by a physician licensed in the same state where Marty’s pharmacy was located and (Marty’s favorite part), no third party payors. Marty would be paid within 2 weeks.

Not only was there a good markup on the prescription cost, but Marty also received a minimum of $10 “shipping and handling” for each prescription order.

The prescriptions were for persons Marty would never see and seldom, if ever, speak to. The customers were Internet shoppers in all 50 states responding to ads that promise “You never have to see a doctor” and “Just answer a few simple questions that will be sent to our doctor who will prescribe the drugs you need.” Marty was told he would have to put in an 800 line so he could offer counseling, but, he was told, no one ever called.

It was too good to be true, as pharmacists from across the country are now finding out.

Not only is prescribing medications for patients a physician has never met questionable medical practice, in many states it is illegal. An Ohio Medical Board rule declares that, with few exceptions, “…a physician shall not prescribe, dispense, or otherwise provide, or cause to be provided, any dangerous drug…to a person who the physician has never personally physically examined and diagnosed…” The Ohio regulation, like many states, applies not only to controlled substances, but to all prescription drugs.

In more and more states, boards of pharmacy are also declaring the filling of such prescriptions to be an unprofessional pharmacy practice. A pharmacist who fills such a prescription may be disciplined, including suspension of license to practice. A recent story in the Des Moines Register told of one Dubuque, Iowa pharmacy’s experience:

Dubuque, Ia. – Federal and state agents shut down a neighborhood pharmacy here Friday amid accusations that it filled thousands of illegal Internet orders for powerful prescription medications.”

It is not just the home state pharmacy board that may be a concern. Every state into which a prescription is sent may attempt to exert jurisdiction over the pharmacy, and even the filling pharmacist. In some states sending such prescriptions into the state may be declared a violation of law punishable by civil or administrative process.

Here is the real kicker: Marty would never have dreamed that in some states he could be considered an illegal drug dealer.

Several states have passed law designed to allow the victims of illegal drug dealers to sue the “pusher” for injury, including the death of a loved one. Some lawyers have argued these new laws are not limited to trying to sell heroin or meth to kids. These aggressive lawyers think they may have found a ticket to large settlements by filing suit seeking to have the pharmacists and physicians declared civilly liable as criminals.

If Marty sends a prescription into the wrong state and a patient claims he or she was injured by the prescription drug, he might find himself being branded a “pusher.” In some of these cases the drug injuring the patient need not have come from Marty’s pharmacy, these lawyers argue. It is sufficient that the patient claims injury by a medication similar to the one Marty sold.

While these legal theories may seem outlandish, the threats and risks are real. Internet pharmacies that advertise physician prescriptions written without the necessity of a regular doctor-patient relationship are not just another mail-order pharmacy. The deals seem too good to be true because they may be so.

If you have been approached to fill prescriptions for such an operation, think twice. If you currently fill prescriptions from physicians who have not seen and examined the patient, inquire as to why. There may be legitimate reasons for such a practice, but explore the reasons.

There is perhaps one safe harbor: the National Association of Boards of Pharmacy’s VIPPS certification program. VIPPS certifies that the Internet pharmacy operation is practicing within certain prescribed legal guidelines. If you are considering filling prescriptions for an Internet pharmacy operation, make sure there is a VIPPS seal displayed on the website. If not, insist that the company apply for one. It is probably the closest thing to a guarantee a pharmacist is going to get.

Perhaps, the bottom line is that all pharmacists should remember the advice their mother gave them: “If it is appears too good to be true, it probably is.”