At the end of the chapter, the reader will be able to:
Understand the risks usually associated with pharmacy dispensing.
Explore the relative numbers of mechanical dispensing errors as compared with intellectual pharmacy claims.
Review the type of errors often involved in prescribing as they relate to the practice of pharmacy.
Discuss how insurance affects pharmacy risks and the decisions to be made by the risk manager.
Pharmacy risk management goes beyond merely putting the right tablets in the bottle with the correct directions on the label. It is even broader than protecting the patient from harm, although that must remain the primary focus of all pharmacists. Risk management means managing a wide spectrum of risks that could affect the practice of pharmacy. It involves protection of the patient, protection of the pharmacists and technicians, and protection of the pharmacy itself.
In this chapter, we look first at identifying some of the most common types of medication errors in pharmacy practice – prescribing, dispensing, administration, and monitoring. For each of these types of medication errors, we will particularly explore the first step in the risk management process, that of identification of the risk. While the risks involved in prescribing errors may usually be more properly described as a medical error, and a mistake in administration may be a nursing error, in the context of pharmacy practice, and the effects on pharmacy patients, the result can be viewed as a pharmacy medication error. The physician may have ordered medication for the wrong patient, and the nurse may have injected the drug IM when it was supposed to be IV, but the problem results in the medication being wrong and the patient injured.
Pharmacy risk management needs to also look beyond medication errors, and explore those risks associated with other quality-related events (QRE) in professional practice. These other risks, while not technically medication errors, have an impact on pharmacy practice and, eventually, how well medication errors are handled and prevented. The other risks we will explore in this chapter are environmental risks, including the environment within the pharmacy or the workplace in general, and financial risks, including insurance coverage for professional liability issues, and exclusions commonly found within professional liability policies.
The first step in risk management is to identify these risks, and to use that information to eventually prevent errors and underlying QREs (plural of QRE) QREs. If we fail to prevent our mistake, we then try to address its consequences and learn from the experience. If we learn from our mistakes, errors, and near misses, we can then identify where the next mistake may be made, thereby preventing future ones. In that regard, we will look at the process by which we record and document, not only errors, but also the near misses, which could have become an error had not there been an intervention somewhere within the system.