Tip of the Week: Be Mindful to Minimize Practice Risks

An element of risk exists in every human activity, and this goes without saying especially in the practice of pharmacy. Risks come in all shapes and sizes—clinical, economic, legal, financial, ethical, and humanistic risks. Risk exists from making an error that can harm a patient; employee diversion or adulteration of drugs; robbery or burglary; brick-and-mortar damage from fire, flood, or other natural disaster; or litigation from employees who have been terminated or disciplined, or who have been discriminated against or harassed. The risks to a pharmacy business are multitudinous.

Different techniques to manage risks include risk avoidance (ex. not providing certain services or carrying certain drugs), risk prevention or modification (ex. procedures to minimize dispensing errors), risk absorption and retention (ex. toleration for some level of customer shoplifting and employee theft of nominal supplies), and risk sharing or transfer (ex. insurance policies).

Researchers James O’Donnell, PharmD, and F. Randy Vogenberg, RPh, PhD, discussed risk management recommendations stemming from malpractice claims. They state that wrong drug and wrong dose errors are the most common causes of monetary settlements or verdicts paid by an insurer.

They also review a list of recommendations for pharmacists in risk management, including the following:

• Think; don’t just act. Question everything—sometimes prescriptions present very obvious and dangerous contraindications. A simple inquiry can avoid a mistake.
• Do not dispense unfamiliar drugs without researching their uses and contraindications.
• Ensure that each computer or hardware equipment is programmed to provide comprehensive, current, and automatically updated drug research.
• When in doubt, ask another pharmacist or call the prescriber.
• Stay within your legal scope of practice.
• Maintain and adhere to appropriate policies, protocols, and systems to identify problems potentially caused by new drugs.
• Treat errors or near misses as teaching opportunities.
• Implement proven technology to reduce the number of steps to the extent possible.
• Provide written instructions and offer every patient the opportunity to ask questions.
• Never assume that similar sounding names are equivalents.
• Do not let technicians bypass safety alerts.

These might seem obvious, but they are often overlooked, especially when pharmacies become busy and we get into the bad habits of assuming and presuming. Of course, prevention of errors and patient safety are among the paramount responsibilities we have as pharmacists. Yet, risks go well beyond these. Many of the above recommendations apply to other types of risk, as well, including thinking and talking to others. Having a mindset of risk minimization will likely pervade other aspects of pharmacy practice and business management or ownership.

Additional information about Risk Management in Contemporary Pharmacy Practice can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

ABOUT THE AUTHOR

Shane P. Desselle, RPh, PhD, FAPhA, is a professor of social and behavioral pharmacy at the Touro University California College of Pharmacy

REFERENCE

O’Donnell J, Vogenberg FR. Legal risk management opportunities, pharmacy practice, and P&T Commitees. Part 2: Risk management recommendations. P&T;2014;39(9):624-626.