Control Techniques
In pharmacy, each pharmacist and pharmacy manager serves as a risk manager. By using the risk management process and applying one or more techniques to control or eliminate the risk, the pharmacist can prevent potential lawsuits, reduce their severity or at least reduce the financial loss to the pharmacy.
The following control techniques are suggested for pharmacist's consideration:
a. Triple check, plus two
We are taught to check each prescription three times: once when it is taken from the shelf, once during the typing of the label, and once during the filling of the prescription. To that, add two additional checks. One additional check should be made just before opening the bottle. This check should be made with the NDC number listed on the computer screen or printout compared to the NDC number on the stock label. Our brain tends to fool us when looking at names we have seen many times before. A check with NDC numbers will catch this error.
One final check should be made when the prescription is presented to the patient. By removing the prescription bottle from the bag, reviewing the directions and name of the medication with the patient and visually checking the contents, we can check one additional time and avoid a potential error. This is also the ideal time and setting to counsel.
b. Counseling
While courts have fairly consistently failed to hold the pharmacist to a defined "duty to warn," a careful reading of these cases over the years shows courts are leaning toward more exceptions. As the exceptions grow, a "duty to warn" will be recognized. Not only does counseling each patient have a sound economic and professional basis, it is also a good risk management technique. In addition to building a defense to a "failure to warn" case, counseling builds rapport with the patient.
c. Documentation
As the pharmacist is recognized more for the knowledge he or she has, the number of claims involving judgment and decisions grows. When the pharmacist is called upon to recall facts which he knew at the time and on which he based his decision, he needs a written record of those facts to assist him. "The faintest ink is sharper than the keenest mind." Documentation may be used as proof of what was in the pharmacist's mind at the time he or she made the decision. It may be proof of a reasonable judgment under the circumstances. "Reasonableness under the circumstances" disproves negligence. Pharmacists need to learn when and how to effectively document.
d. The telephone prescription - echo and verify
Oral communications are easily misunderstood. The pharmacist should train himself or herself to repeat back each part of the telephone prescription. This not only avoids an error of misunderstanding what the physician said, but allows the physician to give second thought to what he or she ordered and the opportunity to avoid his or her errors. After reading back the entire prescription, the pharmacist should ask if it is correct. The pharmacist should document this verification.
e. The use of release forms
Legally and professionally, all medical information concerning the patient is confidential. Pharmacists should release confidential information only when directed by the patient. Release forms should be available in each pharmacy and should be used when the patient's permission is necessary to supply the information to another.
f. Emphasizing to employees the need for confidentiality
Pharmacy employees often have access to the patient's confidential information. Such access is often necessary to be able to serve the patient effectively. All employees should be instructed in the need for confidentiality.
g. Mark it
In each pharmacy, certain drugs cause confusion and lead to more errors and potential errors than other drugs. The pharmacist should identify these "problem" drugs and mark that part of the shelf with a distinctive color to alert the pharmacist when a prescription is filled with such a product.