Pharmacists’ errors in the spotlight
SAPC Vice President
A worrying issue that appears to be occurring more frequently in the health industry is the rise in legal action involving medical or dispensing errors. Medical errors and accidents featured on the agenda at the 2nd National Pharmacy Conference, and presentations were delivered on the possible reasons for the increase in costly legal malpractice suits.
The SAPC is witnessing a growing rise in the number of complaints of medicine dispensing errors being lodged against pharmacists.
Addressing delegates at the 2nd National Conference, SAPC Vice President Douglas Defty said the increase in complaints could be due to patients being more aware or being encouraged to lodge complaints against pharmacists.
He said medication dispensing errors occurred due to the wrong dose being dispensed (30%); the wrong technique of dispensing (12%); the wrong drug being dispensed (12%); patients missing doses (7%); the wrong dose times (7%); and patients being given drugs when they have a known allergy (6%).
“Medical accidents are usually a result of complex system failures and systems that rely on error free performance are doomed to failure. The more steps in a system the more probability of errors. Complex systems need to be redesigned,” said Defty.
“Most errors occur as a result of a chain of events set in motion by faulty system design that either induces errors or makes them difficult to detect, rather than a lack of care or concern on the part of staff,” he said.
Defty said there was a need for non-punitive measures to deal with mistakes due to system failures, but disciplinary action was needed for failure to report incidents, gross incompetence, gross procedural violations, gross insubordination, illegal activity and practising under the influence.
He cited a case in which a community pharmacist on duty in a hospital had mistakenly dispensed a BCG culture used for the treatment of cancer of the bladder instead of a BCG vaccine used for the prevention of TB in children. BCG culture is 50 times more potent than the vaccine which was packaged in a similar vial. “The BCG culture was issued to the labour ward and the sister did not pick it up. Unfortunately, 23 children were administered with a BCG culture. None of them died,” he said.
Defty advised that pharmacists should promote a culture of safety to ensure that everyone on their team was focused on patient safety which included reporting errors with new products and programmes, managing fatigue and developing staff to learn from mistakes.
Pharmaceutical Society of South Africa (PSSA) Head of Public Affairs Lorraine Osman said Minister of Health Aaron Motsoaledi had hosted a medico-legal summit to discuss patient safety, the management of claims, the impact of litigation on the recruitment of specialists, and justice for patients after his department budgeted R24.9 billion for medical malpractice claims across the public sector in 2015. In 2013/14 the state paid out R498 million rand in legal costs for malpractice cases.
Osman said more patients were suing health practitioners because people were aware of their constitutional rights to healthcare and dignity and because lawyers were advertising their services to assist with claims. She said hospital giant Life Healthcare had announced recently that it was closing down its Life Midmed Hospital’s neonatal and obstetrics ward in Mpumalanga due to obstetricians resigning as a result of the rising costs of medical malpractice insurance. But, said Osman, many medico-legal litigation cases could be avoided.
“One of the most important reasons that people gave (for litigating) was that the medical practitioner or the pharmacist did not communicate that they cared for the patient – it was arrogance, and it was attitude, and it was ‘well it is not my problem you had an adverse reaction’. Many of these cases could have been avoided if the health professional could have communicated not only competence but also caring for the patient,” she said.
She said the cost in non-financial terms was greater than the price of indemnity insurance. Insurance cover costs ranged from R450 to R2 160 a year for different categories of pharmacy assistants and pharmacists.
“How would you feel if your healthcare environment should be subject to constant litigation? Why are universities saying they are not getting young doctors coming and saying that they want to specialise in obstetrics? Because there is this feeling of helplessness that they cannot survive in this environment and many people are just too darn scared to do something in case they make a mistake,” said Osman.
Osman said occupational stress was a major risk factor for potential claims. “Because we are understaffed and because there is a lack of resources you work too quickly and you don’t check like you would like to check. It becomes very difficult and you end up feeling totally demoralised. And that can be a major cause of the type of incident that might result in a claim instituted against you.”
Osman concluded that pharmacists felt that they were ‘over regulated and micro-managed’ by Council but regulations were in place to protect them from potential claims.