Opioid analgesics have a way of getting physicians as well as patients into trouble.
These painkillers account for more medical-malpractice claims related to drug errors than any other drug class, according to a new study released today by the medical liability insurer Coverys that illustrates the far-reaching effects of the opioid abuse epidemic. The company analyzed more than 10,000 closed malpractice claims from 2012 through 2016.
Twenty-four percent of medication-related claims involved opioids, even though these drugs accounted for only about 5% of prescription drugs dispensed in 2016, according to published data from QuintilesIMS, a firm that tracks pharmaceutical activity. The next riskiest drug class identified by Coverys was anticoagulants, at 14% of medication-related claims.
In claims involving opioids, “overdoses are primarily what we see,” said study coauthor Robert Hanscom, vice president of business analytics at Coverys. Some claimants also alleged that they became addicted to painkillers. In more than a third of the opioid-related claims, the mistake occurred during the follow-up phase of prescribing.
“Physicians continued to renew prescriptions without monitoring patients to see if they were getting better or not, if there were any changes in their clinical status,” Hanscom told Medscape Medical News. “If patients are still in pain, that’s a red flag. It’s not helpful to keep prescribing the same opioid if they’re not improving.”
In 15% of the opioid-related claims, the physician allegedly “behaved in an inappropriate way,” the report stated. Hanscom said this charge usually boiled down to the physician caving into the requests of persuasive, pill-seeking patients against his or her better judgement.
Anticoagulants join opioid analgesics to constitute the “dangerous duo” in the Coverys study. The biggest pitfall for anticoagulants turns out to be computational and prescribing errors, implicated in 32% of the claims. On-the-money dosing is crucial, said Hanscom, particularly when it comes to “translating blood thinners into the pediatric world.” Another risk is when clinicians take patients off anticoagulants for a surgical procedure, supposedly on a temporary basis, but fail to resume this therapy afterward or don’t resume it quickly enough.
“The Biggest Surprise Is That We Haven’t Seen More Progress”
Medication-related errors and liability were the root cause for 8% of all malpractice claims in the Coverys study, putting it in fourth place behind medical mismanagement (14%), surgical and procedural errors (24%), and diagnostic errors (32%). Hanscom said the role played by drugs has diminished somewhat from what it was 15 years ago, when it accounted for 12% to 15% of all claims. However, he anticipated that it would have been lower than 8% in his company’s new study.
The rise of electronic health record and computerized physician order entry systems in recent years raised hopes of significantly reducing medication errors, Hanscom explained. “The biggest surprise is that we haven’t seen more progress.”
The shift of patient care from hospitals to ambulatory settings may have blunted the positive impact of information technology because the outpatient world tends to be less computerized, he said. In addition, packed schedules in physician offices aren’t conducive to safe prescribing.
“They’re pushing patients through very, very fast,” said Hanscom. “The days when you could sit down with a patient for 30 to 45 minutes and make sure you understood everything about him are really gone.”