Restructuring the law to encourage pharmacists to practice good risk management

Kenneth R. Baker

Every pharmacist who has ever worked for a chain pharmacy is familiar with the incident report. The incident report creates a dichotomy–absolutely necessary for good risk management and absolutely dangerous. All pharmacists are subject to the human frailty of making a mistake. As pharmacists, we know that mistakes can result in serious harm to our patients. If a mistake occurs, we know we need to document what happened to prevent the same error from happening again.

There are several good reasons to make this documentation. If a patient has been injured, we need to report the possibility of a claim to our insurance company or risk management department so the patient can be contacted and any resultant medical bills collected and paid. If the injury is serious, the patient will need to he compensated for his or her expenses and suffering.

Documentation or incident reports are also needed to record the facts surrounding an error because human memory can deteriorate and remembering the facts may be necessary at a later date. One of the most important reasons to document what happened is to use the information to educate the pharmacy staff and prevent future errors. This is the essence of risk management.

The first step in risk management is to identify what errors are possible and, when a mistake does occur, to investigate how it happened. Once this is known, steps called risk management techniques can he developed, which can be incorporated into the filling process to prevent this error from happening again. There is no better time to learn than following a mistake. At no time will the pharmacists and the pharmacy technicians be more motivated to improve the system. We can learn from all mistakes, even those that never reach the patient. If an error is caught before it reaches the patient, the system worked. Incident reports are also useful as a measuring tool in the establishment of a quality assurance program to enable a pharmacy to track improvement–an essential element in quality management.

But there is a problem. Many pharmacists, pharmacy managers and executives are leery of having these incidents recorded. Many errors are never recorded because of fear. Unfortunately, this fear is not without cause. The existence of incident reports, even those recording errors that were caught before they reach the patient, can be harmful if a lawsuit is later filed, even if it is a completely unrelated case. They may be subject to legal discovery and may be introduced in court as evidence of a pattern of negligence. In one Alabama pharmacy [case.sup.1], the plaintiffs attorney introduced more than 250 incident reports collected over a three-year period to show the lack of diligence of the pharmacy chain in training its pharmacists. Because of this, many pharmacies purposefully do not track errors. This problem has also been observed in [hospitals.sup.2].

The solution

Forms and reports used for purely risk management and quality improvement purposes should be protected from routine legal discovery. Many states have recognized this problem in hospital and medical practice. Few states have statutes protecting peer review reports in the area of pharmacy risk management. An example of such a statute is the Tennessee law, TN PracAct 63-10-605.

The law states, “All information, interviews, reports, statements, memoranda or other data furnished to any peer review committee … and any findings, conclusions or recommendations resulting from the proceedings of such committee … are privileged. The records and proceedings of any peer review committee … are confidential … and shall not be public records nor be available for court subpoena or for discovery proceedings.”

These laws do not protect all incident reports, but do protect those reports used and collected solely for the purpose of improving pharmacy practice. Pharmacists from all states should persuade their legislatures of the need and wisdom of such laws for the protection of the patient.

Another part of the solution is for chains to institute a policy that incident reports will not be used for punishment or dismissal of pharmacists or technicians. Rules, such as “three strikes and you’re out,” too often discourage reports. Incompetence can be determined in other ways. Pharmacy managers should review their procedures to protect against unintended consequences.

COPYRIGHT 1999 Lebhar-Friedman, Inc.

COPYRIGHT 2000 Gale Group

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